How do insurance companies effect the job of a pharmacist?

[jessica525]

Unfortunately I haven't had the experience of really working in a pharmacy (just in a hospital), so I have always wondered how the insurance companies play a role. Of course I know they are involved in coverage of medication, but I am unaware of differences, such as HMO vs. PPO, and how this effects the pharmacist's job.

Sorry if this has been posted before, I typed this into search and just found general information about HMOs and PPOs in regards to medicine, not really pharmacy.

Thanks in advance

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[confettiflyer]

well directly, a person's plan formulary will affect what drug a patient can/cannot get covered. This actually (in theory) gives a pharmacist the chance to discuss with the doctor alternatives that may be covered. In practice, though, we just send a fax to the doctors office saying it isn't covered, and they'll fax back an alternative (ie Vytorin not covered, but lisinopril will be acceptable).

But then with less coverage, patients are less likely to be compliant or will forego treatment altogether, decreasing revenue and ultimately, decreasing demand for pharmacists. This probably won't happen, but anyway...my random thought.

 

[jessica525]

thanks for the help