Doctors brace for prescription drug policy changes

"A higher dose of simvastatin puts the patient at greater risk of injury or death," said Zivkovich. "CDPHP doesn't have a license to practice medicine, but they are telling me how to practice."

Zivkovich said that most doctors are irate over the change in policy but are too afraid to speak up for fear of being dropped by CDPHP.

"Seventy percent of my time is spent writing a note to document something for insurance companies to make them happy," he said. "[Before health insurance companies], there was better medicine, better care, and I wouldn't have to be buried in paper work."

Patient care is Zivkovich's main concern, which he said the new policy change by CDPHP is restricting him from doing right by his patients. He accuses the health insurer of "putting money in front of patient care."

He also said switching to generics could actually be more expensive after rebates given by doctors for brand-name drugs. For example, if a patient needs to pay a $25 co-pay he can give them a coupon for a $25 rebate on the drug, essentially reducing the cost to nothing for the patient.

"It's cheaper to get the better drugs," Zivkovich said.

Another argument that has been made by some physicians is that patients who have reached their cholesterol goal on small doses of Lipitor will not be able to tolerate changing to a generic.

Cohoes Mayor John McDonald, who works for Marra's Pharmacy, said that in those cases, CDPHP will provide a way for the patient to access a brand-name drug such as Lipitor or Crestor.

"There will be people who have treatment failure," he said. "CDPHP will provide access to the brand-name drug, but it has to be clinically justified."

Dr. Laura Staff, who runs her own family practice in Colonie, said the application to get those drugs have become increasingly easy over the years, as now a doctor needs to fill out one form on one side of the page showing the patient has failed three months on 80 mg dose of simvastatin and three months on an 80 mg dose of pravastatin. She also added that it only takes a short amount of time to fill out the application.

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