In a newspaper article on Dec. 30, 1996 there was an article by Bob Herbert of the New York Times about the large and increasingly powerful companies that handle the purchase and distribution of prescription drugs for many HMOs and insurance companies. They are called pharmaceutical benefit managers, and their goal is to maximize profits by providing incentives to convince doctors and pharmacists to substitute a drug preferred by the benefit manager over the one prescribed by your doctor.
Mark Green, a New York public advocate, conducted a six-month long investigation of the multi-billion dollar links between drug manufacturers, benefit managers and health insurance plans. He found that more and more, drugs received at the pharmacy by consumers "are increasingly not the ones initially prescribed or desired by their doctors."
The report states benefit managers are "signing contracts with manufacturers and are paid millions of dollars in rebates by them for promoting the sales of particular drugs."
Benefit managers and insurance companies "drastically narrow the range of drugs to be covered by a given plan, and then lean heavily on pharmacists and doctors to make sure the favored drugs within that drastically narrowed range are the ones most frequently prescribed."
When other drugs are prescribed, pharmacists are paid incentives for every prescription they manage to switch. If pharmacists do not do this often enough they risk being dropped from the plan.
Doctors are given lists of drugs covered by a particular plan. HMOs instruct the doctor to prescribe the cheapest alternate instead of the most effective drug. You could end up taking a drug that is a so-called therapeutic alternative that really isn't, and that, in some cases could be life-threatening.
For patients on antibiotic therapy for rheumatic disease it could mean the difference between success and failure.