HOUSTON – It’s called pharmaceutical switching – when an insurance company or other third party doesn’t want to pay for the drug a doctor has prescribed, so they have the patient purchase a generic instead.
"When I go to the pharmacy, they always tell me, ‘This isn’t on the list.’ Or if it’s a name-brand, they tell me they’re going to use a generic that works just as well, but it doesn’t," Yolanda Gonzalez, who takes medication for a severe back injury, said.
And it’s a practice that has many doctors, including Dr. Jorge Guerrero, frustrated.
Guerrero says when he prescribes a certain medication, it’s for a good reason.
"It’s something I know my patient needs," he said.
Critics point to an absence of self-regulation in the insurance industry as a reason for all the pharmaceutical switching, and the American Medical Association called on the industry last year to adopt a new code of conduct.
So far, not one insurer has signed on.
"I think non-medical people in the insurance company are second-guessing the medical people who know what they’re doing," Guerrero said.
In the meantime, he’s had to designate two employees to haggle with insurance providers, almost on a full-time basis.
Guerrero and other doctors say the insurance companies are acting in the name of profit, but it’s the patients who are getting hurt.
