One of the more minor inefficiencies of our vastly inefficient health care system involves prescriptions for over-the-counter medicines.
You see, many insurance plans will pay for your Tylenol, Zyrtec or Flonase — but only if a doctor prescribes them. Otherwise, you have to pay full retail. And for low-income Medicaid patients, like many of the ones I see, this is a major concern.
Combine this with the fact that many Medicaid plans have zero copay, and it ensures plenty of people must stop at the doctor’s office before going to the local CVS pick up their allergy meds, all because of the prescription rule.
So what does that mean to you? It means that $10 worth of OTC meds wind up costing you, as a taxpayer, anywhere from five times to over ten times that, once you add in the cost of the office visit (code 99203 on the provided links). After all, I don’t work for free.
Now don’t get me wrong: my employer certainly appreciates the increased revenue this idiotic prescription rule provides us. In peak allergy season such as now, a clinic in a poor neighborhood can easily see half the patients of the day just there for OTC meds. All that bonus taxpayer money adds up quick.
But as a matter of public policy, perhaps a different rule could be considered. Patients could get their Motrin or Miralax covered at the pharmacy without having to go to the doctor’s first, up to a reasonable max per year. How many millions would that save Medicaid and Medicare per year?
On the other hand, I personally have a vested interest in keeping this rule in place as noted above, so therefore I should write my state legislator to oppose any changes. Maybe even donate to her re-election PAC! Hmm, so this is what regulatory capture feels like… feels sinfully great!
Joking aside, while this is a pretty minor problem compared to some of the outrages foisted on us, it does illustrate nicely how American health care screws over the patients (who must waste time or even take off work coming to me) and the taxpayers, just to benefit clinics and hospitals. And I’m sure more powerful interests than me really would move to oppose any changes.
So yes, I appreciate that extra income my often cash-strapped employer gets. But it doesn’t mean I have to like it.