Switch Hitter

By Fleming, Harris Jr | Drug Topics, March 15, 1999 | Go to article overview

Switch Hitter


Fleming, Harris Jr, Drug Topics


Oxford goes one step further in encouraging product switches, sends prescription order to the patient

At least one major health plan has taken its approach to product switches a step beyond the standard letters usually sent to patients. Some managed care and pharmacy insiders, however, say it is one step too far.

Providers and patients receive "switch letters" from health-plan physicians and pharmacists regularly, suggesting that a particular product might be better suited to a patient than the one originally prescribed by the primary care physician. Often, managed care organizations receive price breaks from manufacturers based on Rx volume; the MCOs may then offer financial incentives for pharmacists and physicians to encourage use of medications on formulary.

However, Oxford Health Plans implemented a pilot program that included sending actual prescription orders along with switch letters. Drug Topics has documentation of two such instances, in which the prescriptions were signed not by the patient's regular physician but by doctors who had never examined the patients before. The letters were written on Oxford letterhead.

Two plan members complained about the program in a recent news report by WNBC-TV in New York City. Leslie Gersing, a producer at WNBC, invited Drug Topics to discuss the role HMOs play in Rx decisions in preparation for that report. One of the Oxford members quoted in the story said she felt it constituted an invasion of privacy and made her feel "like a laboratory rat."

According to an Oxford spokeswoman, the initiative was a voluntary pilot program, lasting several months in 1998, designed to provide more affordable care for members. "If either the primary care physicians or the members did not want to participate, then they didn't have to," she said. "These were drugs that were found to be just as efficacious as the ones that would cost more money" The program was discontinued when Oxford concluded "it could probably do better saving money other ways," the spokeswoman said. Though she did not know the exact number of patients involved, she said the program's population was "fairly small."

According to the letters and prescriptions seen by Drug Topics, one patient was encouraged to switch from Vasotec 5 mg (enalapril maleate, Merck & Co.) to Zestril 10 mg (lisinopril, Zeneca Inc.). Another was asked to fill a prescription for Dilacor XR 240 mg (diltiazem HCI, Watson Laboratories) to replace Cardizem CD 240 mg (diltiazem HCI, Hoechst Marion Roussel). …

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