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Fight for Doctors' Right to Prescribe is Alive in Rockland

Without the program, insurance companies can decide what medication patients receive.

Laurie Lindell suffered lingering nerv damage in her right hand when she was hit by a car in 2001.

Lindell’s doctor often talked to her about leaving her job as an office manager in the manufacturing field, but Lindell didn’t want to stop working.

“I like to work, I liked my job,” she said. “But the pain didn’t really go away and just got worse. Some nights I’d go home and cry because of how much pain I was in.”

Her doctor also prescribed various medications, which helped with the pain, Lindell said. However, her insurance company didn’t think she needed the medication, or any at all.

“They would tell me it’s all in my head, that I didn’t need it,” she said.

Lindell knew how she felt, though, and knew the pain only got worse over the years since the accident. She took disability leave in October 2011 because she couldn’t keep performing her job with her injury. The doctor and Lindell continued to fight the insurance company so she could keep receiving the medication.

Her doctor also put her in touch with the New York Pain Society, from which she discovered the U.S. Pain Foundation. Lindell, who lives in Long Island but was raised in Bardonia and graduated from Clarkstown South, is now the vice president of development for the U.S. Pain Foundation, advocating for others going through similar issues with insurance companies.

On Thursday, Lindell and a group of advocates joined State Sen. David Carlucci at the Mental Health Association of Rockland County in Valley Cottage to urge Gov. Andrew Cuomo to reinstate prescriber prevails for atypical antipsychotics in the 2013-2014 state budget. Prescriber prevails ensures that only doctors and physicians have the authority to prescribe medication.

“We want to make sure that prescriber prevails stays in the budget, that we fund it, that we make sure that insurance companies don’t get in the way of a doctor and their patient,” Carlucci said. “Right now, what we see is that these insurance companies or manage care providers, what they’re doing is really sitting back and having these prescription benefit managers — basically, what you could call almost like actuaries — sitting back in an office and deciding which medications are appropriate for a patient that they’ve never seen.”

Carlucci and Lindell gathered Thursday with President/CEO, Mental Health Association of Rockland County Stephanie Madison, Jawonio Division Director of Behavioral Health Services Sharon Kuriger, Jawonio Director of Personal Recovery Oriented Services Dr. Joe Zweig and Rockland Independent Living Center Senior Peer Specialist Levi Riddick.

Riddick said many patients he deals with are most comfortable living with a certain routine, and even the slightest deviation could “send them into a tailspin.” Because of that, he doesn’t think it’s a good idea to possibly switch medication so swiftly for patients. Also, many of them develop relationships with their physicians and call them for help. He said it could be dangerous for the patients to seek out help only to be put on hold by an insurance company or not get to talk to a person.

Carlucci said the program comes with an appeals process if the new medication prescribed by the insurance company isn’t working, but that could take weeks, which gives plenty of time for the patients to destabilize. He also said that with the recent debate about gun safety, the phrase “mental health” has been thrown around quite a bit, but something like taking away prescriber prevails shows a lack of understanding about mental health.

“I’m beginning to think that a lot of these pundits don’t even know what mental health means, because they say we need more mental health services, better access, and then you see policies like this come out, where we’re saying yes, someone might not anti-psychotic medication and we’re going to deny them that medication,” he said. “So this is very troubling, and I think it’s important that we, as leaders in New York state, that we put our money where our mouth is and we actually deliver on these services.”

He also said that changing medication on the patients could result in an increase in the number of people needing to go to the hospital, so any costs one might think would come from not reinstating the program wouldn’t really help.

“This is, ultimately, about saving money because this is an issue where if we do it wrong, we’re going to pay more in the end,” Carlucci said. “And if we’re looking at saving Medicaid dollars, reversing prescriber prevails is not the way to go. Reversing prescribe prevails, all we’re going to do is increase the bottom line for insurance companies and those stockholders and decrease the bottom line for us, the taxpayers. We’re going to be paying more in Medicaid by sending people to emergency rooms and worsening their care.”

Lindell said that not only could taking away prescribed prevails result in more trips to the emergency room for patients, but it makes them feel like a number rather than a person. While going through her issues with the insurance company, Lindell said she felt extremely demoralized.

“You feel like nothing,” she said. “You feel like you don’t exist. You really have to have a good doctor and someone willing to fight with you. Without the right support system, you’re in trouble.”

Zweig noted that people with mental health problems typically live shorter than most, and Carlucci said treating people with incorrect medication could further harm them.

“Unfortunately people suffering from mental health issues have a shorter life expectancy, and not because of their condition but because of the drugs that they’ve been taking, in many cases,” Carlucci said. “Switching someone from a drug that the doctor knows works to another drug is just really a prescription for failure.”

mary February 22, 2013 at 06:03 PM
Thank you to all listed above for continuing this fight. It is so important, as I have been through that time and time again, as the insurance company tells me which drugs I have to take, not the DR. Very very frustrating. I thank you all from the bottom of my heart.
steve scarpinTo February 22, 2013 at 11:06 PM
You think it's bad now wait till Obama care kicks in then you will really have something to complain about
Jody Fox February 24, 2013 at 04:29 PM
When you have an insurance companies judgement based on generally accepted practices substituting for a professional medical physician's judgement you have bad Medicine. We need to a large group of lawyers stepping up to the plate and suing the Insurers till it becomes more expensive to defend than provide the medical care. If we are not going to provide the medical care that physicians are taught, why have medical schools. We can insurers make all the medical decisions and lawyers suing them routinely for wrongful death or damages.

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