What does a prescription mean to a patient? To most it is obviously medicine to treat disease, perhaps to sustain life. But to health insurers, employers, pharmacies and others a prescription is a benefit. A benefit is something to be authorized, approved, controlled, processed and cost-managed. Its use as medicine may hardly even be considered. A prescription handled as a benefit can be delayed or denied without concern for the health consequences to the patient.
If you are not aware of this you are not prepared to be a patient or caregiver in the U.S. healthcare system.
A terminally ill patient may be denied medication because medication was not prescribed as dictated by the benefit manager.
Management requirements vary so greatly between providers that no prescriber can know all the requirements for all providers.
So, you may be given a prescription that cannot be filled.
Your pharmacy may not even know what to do with a prescription it receives.
You may never see your prescription or know where it was sent to be filled.
Your prescription may simply get lost.
Prescriptions can get lost in the healthcare maze. A doctor writes a prescription that is submitted by a nurse to a pharmacy. A pharmacy seeks authorization from an insurer who needs approval to fill the prescription based on the patient’s benefit agreement. A benefit manager responsible for controlling costs outsources approval to a subcontractor who monitors all of your prescriptions. The subcontractor approves or disapproves filling your prescription based on its analysis of the insurer’s cost objectives and your history of prescription benefit use.
You may or may not receive your medication when you need it, and your doctor and nurse may never hear of the fate of you or your lost prescription.
All of this occurs in compliance with standards of care and approved procedures ostensibly in place to protect patients.
Your prescription is unfillable if it cannot navigate every twist and turn of healthcare maze.