Politics & Policy

The Devil Made Me Do It

HMOs and prescription-drug insanity.

There’s a joke circulating on the Internet that goes something like this:

And God populated the earth with green and yellow vegetables of all kinds, so Man and Woman would live long, healthy lives. And Satan created McDonald’s. And McDonald’s brought forth the 99-cent double cheeseburger. And Satan said to Man, “You want fries with that?” And Man said, “Super-size them.” And Man gained pounds.

And God created yogurt, healthful and pure. And Satan froze the yogurt and created chocolate fudge and sprinkle toppings. And woman gained pounds.

And God brought forth running shoes, and Man resolved to lose those extra pounds. And Satan brought forth cable TV with remote control so Man would not have to toil to change channels. And Man gained pounds.

And Satan saw and said, “It is good.” And Man went into cardiac arrest. And God sighed and created quadruple bypass surgery.

And Satan created HMOs.

While folks who have suffered through the frustrations of dealing with managed-care companies may be snickering at the joke, the nation’s second-largest HMO, WellPoint Health Networks, has filed a petition with the Food and Drug Administration (FDA) that is no laughing matter.

WellPoint has asked the FDA to initiate a forced switch of certain non-drowsy allergy drugs from prescription-only to over-the-counter status. On first blush, this sounds like a good thing. But on closer inspection, forced over-the-counter switching of prescription drugs turns out to be bad for consumers, politically unwise, and legally questionable.

A portion of your paycheck goes to pay for your insurance benefits, and one of those benefits is prescription drugs. Currently, I pay $5 for a prescription, and sometimes more, depending on a variety of factors. If a drug becomes over-the-counter, however, I then pay full price. Yet somehow, my health-care premiums only go one direction: up. You don’t need to be an economist to realize that paying more dollars for fewer benefits is not a good deal.

WellPoint stands to gain as much as $90 million a year in drug expenses from OTC switches. But according to a report commissioned by the Center for Individual Freedom Foundation, “the direct costs to patients for allergy medications Allegra and Zyrtec will rise precipitously if [FDA] approves the change from prescription to over-the-counter status requested by WellPoint….” In short: Good for WellPoint’s bottom line, bad for the consumer’s pocketbook.

When prescription drugs become over-the-counter, the doctor is effectively taken out of the process. Of course, like many folks, I don’t like going to the doctor — who has that kind of time? But one of the main reasons to have prescriptions in the first place is so that your doctor can manage the usage of your medications. The price of convenience, when it comes to avoiding a prescription and a doctor’s visit, could literally be your life.

According to an American College of Allergy, Asthma and Immunology (ACAAI) survey, 95 percent of allergists believe that recent widespread changes to health-insurance coverage interferes with their ability to provide the best possible care for their patients. Furthermore, 70 percent of allergists say that a reduction in coverage has resulted in worse health and well-being for their seasonal-allergy patients. The ACAAI was prompted to commission the survey because, in addition to increasing co-payments, many HMOs are now requiring proof than an OTC medication does not work before they will cover a prescription.

So we’re supposed to risk letting our condition worsen while waiting for OTC medication to work before an HMO will pay for a prescription? What cost-cutting bureaucrat came up with that brilliant idea?

If the HMOs are successful in forcing over-the-counter classification for drugs such as Zyrtec and Allegra, it would only be a matter of time before they attempted to push other drugs out of prescription status. An asthmatic for 32 years, I have seen many dramatic improvements in the treatment of allergies and asthma. Through the first ten years of my life, inhalers were not available. Some of the earliest inhalers weren’t too terrific either.

Basically, there are two types of inhalers — preventative and emergency. To manage the disease effectively, you have to take both; otherwise, you could end up using your emergency inhaler too often and reducing its effectiveness over time. Once an emergency inhaler stops working, the next stop is the emergency room. An asthmatic simply must work in concert with a doctor to ensure that the preventative medications are working to minimize the symptoms.

One inhaler, “Primatene Mist,” is already an OTC asthma treatment. Many pharmacies are keeping it behind the counter because it is one of the most stolen items from stores, due to its high cost. However, abuse of inhalers like Primatene Mist is rampant. In one infamous case, it was determined that abuse of Primatene was the cause of death for 17-year-old model Krissy Taylor in July 1996.

Allergy medications are an important tool in the management of asthma — a growing problem in inner cities. The one-two punch of both making allergy medications cost-prohibitive and taking the doctor out of the equation could not only jeopardize the health of patients, but also seriously overload already burdened emergency rooms. Saving bucks at one end of the system will only cost big bucks at the other end.

The FDA’s legal authority has even been called into question. According to the Washington Legal Foundation, “The FDA lacks authority to force an unwilling manufacturer to switch its distribution channels from prescription to OTC. When one examines the applicable section of the Food, Drug and Cosmetic Act, the authority just is not there… nothing in the Act authorizes FDA to take the next step and prohibit Rx or require OTC distribution of a safe drug.” A government agency overstepping its bounds? Say it isn’t so!

And even apart from the legal issues for the FDA, there could be political issues for the White House. The average American may not be able to name the FDA commissioner, but he sure doesn’t want whatshisname messing with his prescription drugs. Just ask any senior citizen if he would like to pay more for his medication.

If these medications do achieve OTC status, complications in patients could be inevitable. Whether it’s a case of self-medicating or drug interactions, liability factors will certainly come into play. Fresh off their victory over tobacco companies, the trial lawyers would soon begin circling, hungry for their next conquest.

National Legal and Policy Center chairman Ken Boehm, citing a survey sponsored by his group in April 2003, said: “After hearing both sides of the argument, American consumers do not believe the potential convenience of moving prescription allergy medications to OTC outweighs the potential health risk and the anticipated cost-shifting.”

WellPoint is leading the charge in shifting drug costs on to consumers and in premium increases to its customers. That comes with a public-relations price, however. A 2003 Harris Poll found that only four percent of consumers found managed-care companies generally trustworthy.

Satan has better poll numbers.

Kay Daly is the spokesperson for the Coalition for a Fair Judiciary.

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