This post is by Amanda Anderson, RN, CHMP’s Graduate Fellow. Amanda is a current student in Hunter-Bellevue School of Nursing’s dual MSN/MPA program, and an ICU nurse. Her blog is called This Nurse Wonders, and she tweets as @12hourRN.
Over eastern European food and mosquito swatting on a patio in the East Village last night, friends and I got into a bit of a debate about health care. My friend’s boyfriend, outnumbered in sex and occupation (the rest of us were nurses) brought up his hearty conviction: Health care in America is overwhelmingly imbalanced solely because of Big Pharma. Drug companies in the US have free reign to charge whatever they want, he said, whereas in Europe, where he’s from, insurers reject high-priced schemes.
I’ll be the first to admit that I spend little time studying European economics, but I did read an article in last week’s New York Times about this very topic, which I brought up in response to his statement. In, Health Insurers Pressing Down on Drug Prices, Andrew Pollack writes on how, since the Affordable Care Act’s inception, insurance companies have started to fight back against drug-makers. His article argued similarly to my friend – without competition, drug companies keep prices insanely high, and with little justification. His added analysis – American insurers, finally fed up, are now starting to push back by kicking high-priced drugs off of their plans.
Perfectly proving my friend’s point, the article confirmed that Big Pharma is unchecked here in America, and needs to be reigned in. Booting pricey drugs off insurance plans seemed a logical first step. But the nurse in me jumped up like the little kindergartener in the back of the classroom, waving his hand in the air, shouting: “What about the patients?!”
Yes, the article eventually touched on the problem that this seemingly beneficial strategy poses: Great, we’re calling out ridiculous drug prices, but what about patients who can’t get their meds? But to my too-oft dismay, a physician was interviewed for comment; Dr. Brian K. Solow, chief medical officer of OptumRx. His statement – that the changes in strategy may not be best for the patient – was valid, but left me wondering what a nurse might say.
Medication teaching comes straight from the mouths of nurses. During hospitalization and upon discharge, it is a nurse’s responsibility to educate patients on the medications they are receiving and the prescriptions they are sent home with. The current HCAHPS survey asks not one, but three questions about the quality of education surrounding medication administration – a clear indication to its measured importance.
Much of this education doesn’t center on complex physiology, but primarily on medication name recognition. It amazes me how many patients don’t realize that their Plavix is also called Clopidogrel. I’ve heard stories of mental health patients relapsing because their doctor ordered them a generic drug, but never told them that a trade name existed. At the pharmacy, paralyzed by paranoia, they refused to accept the foreign drug because they hadn’t been taught of its synonymy.
Nursing is responsible for these lessons, and as such, offers a much-needed voice of perspective in policy articles like Pollack’s. If I had been consulted about this topic, I would have talked about the high risk, the great cost, and the incredible need for education that fragile, often elderly patients require, while maneuvering the swamps of health care and complex medication regimens.
While this pushback from insurers will likely bring big-picture benefits to patients as Big Pharma is further controlled, I do hope that nurses will start voicing their concerns to the media, about its immediate effects. Yes, doctor, what is best for patients is our goal, too, but sometimes, implementation of that “best” is quite complicated.