by Seth J. Baum, MD

All physicians and other health care practitioners (HCPs) recognize the insidious process that has undermined our ability to properly care for our patients. Patients don’t yet fully grasp this, but they are beginning to do so. Over the last two decades HCPs have been commoditized – all doctors are considered to be equivalent. Like concrete, one doctor is purportedly as solid as the next. Along with this distortion has arisen the belief that someone – or something – other than an HCP has patients’ best interests at heart. Doctors, we are led to believe, require “breaks” lest they over-prescribe and over-treat their patients. Even when there is irrefutably no conflict of interest in a physician’s prescription, he or she is assumed to be incapable of crafting the proper recommendations. And so we have insurance providers who daily tell HCPs what they can or cannot prescribe for their patients. In turn, we physicians argue and fight to get providers to pay for the medications and treatments that only we – highly trained and deeply knowledgeable about the nuances affecting our particular patients – can accurately advise. But the battles have become burdensome and the payers are winning. The patients therefore are unwittingly beginning to lose.

So here are five steps we can take to turn the tide and regain our patients’ rights to receive that which they require:

1. Demand a peer-to-peer review for all lipid-lowering medication denials. Let’s start with this realm, as it is currently the most prevalent and contentious.
2. Obtain the full names of those denying care – doctors and ancillary staff. Memorialize them in patients’ charts, and inform the deniers that you are doing so. Their feet must be held to the fire. They cannot be allowed to hide behind a corporate veil of anonymity.
3. Maintain a list of patient information along with the denials, insurance providers or PBMs, and “peers’” names.
4. Counsel your patients to contact their insurers and even their congressmen. Help the patients understand the gravity of their denials and the unfortunate helplessness we physicians experience.
5. Send me your contact information and I will consider ways for us to work together to win this battle. Email me at: lipids @ preventivecardiologyinc.com. Please also send your suggestions regarding next steps.

We are hundreds of thousands of doctors treating hundreds of millions of patients. Our voices should be loud and resonant. This has gone too far. Let’s turn it around.