Tuesday, September 8, 2009

Why I lose sleep

For the umpteenth time this year, I have received a request to change a medication from a prescription drug plan (this is a government-run one, but others are guilty of the same stupidity) that reads something along these lines:

Dear Doc,

We have reviewed the medications of your patient and would recommend that you switch him/her from the medication you prescribed (clonazepam-a benzodiazepine) for insomnia to zolpidem (a benzodiazepine-like medication). Studies have shown that chronic usage of benzodiazepines can lead to tolerance and addiction... etc, etc. A form (which looks almost identical to a standard refill request) is sent along for my convenience.

So, no big deal. Right? The insurance company wants to use the "safer" medication and ensure quality care for it's client. Except, over the past few years (until last summer), I was receiving letters from the same prescription drug plans that looked something like this:

Dear Doc,

We have reviewed the medications of your patient and would recommend that you switch him/her from the medication you prescribed Ambien (zolpidem) for insomnia to clonazepam(or other similar benzodiazepine). Zolpidem is not approved by the FDA for the treatment of chronic insomnia, and will not be covered... etc, etc. A form again is sent along for my convenience.

To review, the insurance company is requesting that I change their recommended medication to their previously rejected medication. What gives? Did the FDA approve zolpidem for chronic insomnia? Nope. Did benzodiazepines suddenly become more dangerous than previously thought? No. What DID happen is simple: zolpidem became available as a generic. And the benzos got sent back to the "bad drug" bin.

I'm all for cost cutting in health care, and the reality is that benzodiazepine and nonbenzodiazepine sedatives have both risks and benefits, and both are acceptable classes in the treatment of insomnia. Zolpidem is even noted to have some abuse potential (especially for those who choose to use other chemical means to stay awake after taking it). However, phony-baloney excuses by the insurance companies only to save a buck are criminal. If the makers of these medications tried marketing using these practices, they'd be in court faster than you could say class action.

Don't believe me? Ask a doctor how easy it is to get approval for a switch to Ambien CR, Lunesta, or Sonata--some of the other nonbenzodiazepine sedatives--which happen to not be available in a generic. Oh, and by the way, Ambien CR is approved for the treatment of chronic insomnia.

I need a nap.


Dreaming again said...

been down that road as a patient. The sleep meds ..as aggrivating as it's been ...was not nearly as upsetting as them forcing me to switch from Cellcept to Imuran ..Imuran has been tried, and failed ..yet they insisted thatI try it again and my other choice was no immunosuppressant (for autoimmune disease ..yeah huh).
the fact that Cellcept is significantly safer, less risk for both cancer and kidney/liver damage is beside the point, it's 1/10 of the cost ..so who cares!

Doc said...

Sadly, too many docs are too tired, busy, or jaded to really go to bat on these cases. I make it a habit to fight for everything, with naïve hopes that it will maybe result in less requests. Sleep agents are certainly not alone in the classes of meds picked apart by insurance companies. Some of these med decisions can truly mean life or death for the patient.

satishsoli said...
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Clerk said...

If you are encountering consistent problems in falling asleep at night and are unable to cure your insomnia in spite of putting in your best efforts, you should soon pay a visit to the doctor. After evaluating you as a victim of the sleep disorder insomnia, the physician may prescribe sleep aid pills such as Ambien, Lunesta et al for you but to extract maximum benefits from the sleep aid pill, it is to be taken as per the instructions of the doctor. However, before you move ahead to treat your insomnia with Ambien, it would be considerably beneficial for you to obtain first hand information on Ambien from the website http://www.sleep-aid-pills.com/.