October 7, 2007

This Is What You Wanted, Right?

Remember all those articles about bipolar needing specific treatments, and that you should never use an antidepressant? 

I have a guy on Zyprexa and I add Lexapro, patient comes back the next day and says the insurance wouldn't cover Lexapro, and hands me an insurance rejection which says exactly this, punctuation included:


Clinical Review Third Party Override Required.  Prescription had the following Clinical Review message(s)- "Lexapro Oral Tablet 10MG should be used with extreme caution in Bipolar Mood Disorder, which is a proxy medical condition based on the use of Zyprexa Oral Tablet 5MG." and "USE FLUOXETINE PAROXETINE SERTRALINE CITALOPRAM"


In case you're missing the beautiful irony, let me extrapolate the rejection's four points:

  1. Didn't you psychiatrists all agree that antipsychotics are "anti-psychotics" and thus only for bipolar or psychosis?  We assume you are rigorous, therefore this must be a bipolar patient.
  2. Didn't you psychiatrists all agree antidepressants, like Lexapro, were dangerous in bipolars? 
  3. Fortunately, we at the insurance company caught your oversight before it was too late; disaster averted.  No need to thank us, your silence is sufficient.
  4. Oh, and BTW, if you ever do want to use Lexapro, don't-- please use these generics, which are ipso facto safe in bipolar, as they are generics. 

It's only a matter of time before the insurance company adds:

  • You know, this is pretty easy; the meds do all the work, and we have to catch your mistakes anyway.  So, we're going to reduce the Medicaid payment for office visits to, I don't know, $35 for an office visit. Oh, wait, we do that already!  BWAHAHAHAHAHAHAHA!  We'll just get the primary doc to do it.

You're going to say, no, that'll never happen.  Oh yeah?  Did you expect this to happen?