healthcare system

Healthcare System: Current State: System Failure

One example of a system failure is the American Opioid Epidemic. Health plans commonly make it harder for patients to fill more expensive, less addictive pain management drugs (Volkow, 2016). They do this by requiring prior authorization, quantity limits, and contingent therapies. These restrictive measures are set on the plan’s formulary and essentially drowned prescribers in paperwork. Similarly, health plans limit the duration of therapy on drugs that treat opioid dependence even though it is a chronic condition. This is because the drugs are expensive and health plans don’t want to pay for them. Not all of the blame for this epidemic can be placed on health plans. Drug manufactures have much control in lowering drug costs. This epidemic is not due to a lack of knowledge; it’s due to a lack of implementation. We as a society created this epidemic. To fix it is not a choice, it’s a responsibility.

Another system failure is in the Medicare and Medicaid system. The sheer complexity of the system explains how convoluted it has become. There are numerous players in this system: health plans, government regulations, prescribers, pharmacies, and drug companies. Contracted pharmacy rates, various drug pricing methods, complex manufacture discount calculations, health plan transition policies, benefit phases, out-of-pocket thresholds, incentive fees, administration fees, etc. all contribute to the failures of the healthcare system. And pharmacy insurance is just one segment of the healthcare industry. Lastly, a knowledge term of 10-15 years is unacceptable. There needs to be incentives for drug companies to get new, less toxic drugs to market faster. Health research institutions need permission from their Internal Review Boards (IRBs) to publish their research findings (Esserman, 2016). If researchers needed permission to not publish their data, maybe more drugs would get to market faster.