Good
morning!
What do you mean my drug
is "NOT ON THE FORMULARY!" ?? OK….What can I DO about it?
Sound familiar? Patients feel powerless
because a great, unseen but purportedly all-knowing THING
(called a P&T committee) is beyond their reach or ability to
influence. Call center representatives feel a similar despair
because they have nowhere to send these people (Client HR
departments DO NOT want members referred back to them!).
Sure the HR departments get their share of spontaneous complaint
calls when members do not feel they are being heard. An appeal
(written) can be filed but does not guarantee satisfaction.
Solution?
I propose that all PBM's should initiate
one or both of the following:
1) set up a voice mail box for formulary status feedback.
2) set up an e-mail box for formulary status feedback.
Call center reps and client HR
professionals would have a place to triage dissatisfied members.
Each petitioner would be asked to supply the client name,
formulary (if known), product, and the reason for the request.
Followed by an educational message acknowledging that their
concerns will reach the decision makers.
Now comes the real heart of the idea….
All feedback MUST be compiled and presented to the P&T committee
on an annual basis. Action is not necessary but would remain
possible. Expectations would need to be managed. Members should
be taught to expect to be heard and to have their
feedback considered but not expect an automatic democratic
change. PBM's could learn that certain "Therapeutic
alternatives" are lacking, exceptions for some dosage forms
should be part of the formulary, and any number of other ways to
improve the process.
While this may not be perfection…. it
would certainly be progress.
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