Evaluating The Therapeutic Package for Diabetic Patients: The Whole Exceeds the Sum of Its Parts

Abstract

A s health professionals treat patients under the Medicare Modernization Act, subtle but important changes in the experience of designing drug treatments for diabetes and related disorders are becoming apparent. The first change to affect providers is a clear rise in the frequency of requests for “prior authorization” of nonformulary prescription agents. This increase was a predicted effect of Medicare D, and its impact on physician work patterns and the costs of rendering care to diabetic patients is not at all welcome.1 The increase in prior-authorization requests may also reflect a greater consumer awareness of insurance coverage for drugs and greater resistance to obtain drugs that are costly but not covered by insurance plans. As physicians are, in some way or another, profiled about the outcomes of the diabetes care they render (“pay-for-performance”), changes in physician prescribing behavior are predicted.2,3 All of the recent and coming influences on providers and patients alike may lead to essential alterations in how both physicians and consumers view drugs that are prescribed for the treatment of individual patients. The composite effects of these trends on prescribing behavior have not been fully assessed. However, there are many reasons to suggest that profound changes may be imminent in how physicians, patients, and pharmaceutical vendors interact over the selection of pharmacological agents and medical devices in the care of diabetic patients. Given the profound impact we are already seeing in the numbers of prior-authorization requests under Medicare D as an index of these coming changes, an assessment of these possible trends may be helpful to diabetes care providers. Experienced physicians know well what has not been clearly stated in the literature until recently: that the customary decision-making processes that are typically used to select treatments for diabetes and the influences used to encourage …