Driving In Traffic

A lady called physician’s office with whom I am working. She was distressed because all of a sudden she was unable to get one of her medicines because she needed our office to submit a prior approval application.

She was frustrated, upset and worried about what she was going to do since she was almost out of medication. She was also feeling singled out and picked on by the insurance company.

With that experience fresh in my mind, here are 10 things to know about the medication prior approval process.

1. You certainly are not alone. Increasingly, insurance companies and pharmacy benefit managers are implementing prior approval requirements for certain medications (mostly brand names where generic alternatives are available).
2. Every insurance plan has their own custom prior approval requirements. Many think that their insurance plan is the name of the company that insurance plus the product (example: Blue Cross Blue Shield PPO, Aetna HMO, Blue Cross Blue Shield POS). Actually, your plan is customized for your group. So there may literally be thousands of different plans underneath the umbrella of the type of insurance you have. Subsequently, it is next to impossible for your prescriber to know which medications need prior approval and what the approval criteria is for specific medications.
3. Brand name medications that are used to treat attention deficit disorder, insomnia, asthma, allergies, erectile dysfunction, irritable bowel syndrome, rheumatoid arthritis, osteoporosis, osteoarthritis and elevated cholesterol levels often require prior approval.
4. To get drugs approved, most pharmacy benefit companies have forms that must be completed by the doctor. Some companies do have phone numbers to call, but here again, this needs to be done by someone in your doctor’s office.
5. Medication prior approvals usually expire after a year.
6. Some medication prior approvals are for specific doses of medications. If the dosage changes, you may be required to seek another prior approval.
7. Because of the increasing numbers of medicines being added to prior approval lists, medical offices are very busy responding to requests for prior approval. Please give your provider’s office at least a week to complete the process.
8. Once the medical office completes the process, sometimes it takes up to three days for the approval to get into the system so that the pharmacy can fill the prescription.
9. Information that is needed for medication prior approvals can include: your name, your insurance subscriber number, your birthday, your diagnosis, and prior medications used to treat your condition, dates of treatment and reasons they were discontinued.
10. Patients/consumers can really be of assistance by keeping up with the expiration dates of medication prior approvals. Many prescribers are happy to help a patient that is trying to make this process easier.

The second post of my Niche Marketing Series is up at Trusted.MD. Drop by to leave your comments and thoughts on the power of being a resource to your colleagues and how this can further you niche marketing efforts.

OK– the live blogging thing didn’t work out too well. Mostly because I couldn’t stay connected to the Emory network. Everytime I shut my laptop — it would ask me to re-register. I’m not whining– I’m just explaining… ok… maybe I’m whining a little bit. Anyway, the day was filled with a lot of helpful hints and tips for the newbie and the advanced podcaster. As a newbie, I found the following tidbits helpful:

1. The average podcast is about 20 minutes long. It is always better to be brief rather than long-winded.
2. Start podcasting with a minimum set of hardware & software (free if possible) and give yourself a path for upgrading.
3. There is indeed a minimum leve of sound quality you need and a good $40 USB headset with microphone should be able to get you there.
4. Audacity or Garage Band are two good tools for editing your audio.
5. MP3 is the only universal format and good audiofiles have a bit rate of 64kbps-128 kpbs (96 is good) and a sample rate of 44.1khz.
6. If you don’t have a blog, there are many services that will publish your podcast.
7. Gabcast will let you record your podcast via a toll free number.
8. Podcast directories are good for promoting your blog. Good ones include: www.podcast.net, www.podcastdirectory.com, www.podcast411.com, and www.podcastalley.com.
9. Freevlog.com is a good resource for vlogging.
10. There are a bunch of helpful folks in the podcasting, blogging and vlogging space. If you are interested and/or need help, don’t be afraid to ask someone. Most are willing to help and give advice.

Tags:PodcampAtlanta podcasting vlogging PodcampAtlanta2007 social media

This morning I am attending Podcast Atlanta. Since there is wireless and my computer has become my ole ball and chain… I fully intended on live blogging if I could.

I brought my camera– but it makes too many beeping noises. I’ll be posting pictures later. You can see pictures at flickr .

Dan Greenfield posed the first question of the morning. That gets at how many social media skills are enough. Balancing time resources– how does one know what is enough and should we feel bad that we don’t participate in enough communities.

The overwhelming consensus in the room is to attend to your own needs. Don’t feel guilty or bad if you cannot do everything. The most important aspect is to remain faithful to your own needs and the applicability to the audience you target. Do what you do well. Don’t waste worry or guilt or energy trying to get engaged in every social media community out there.

more later….

Tags: podcampatlanta, podcamp

As I stated in my last post- I’ve got a big case of blogger guilt. Too much to do and Driving In Traffic is suffering. When I write a post for Trusted MD, I usually try to cross post it here. Well… in an effort to save a lot of time not having to reformat and such, this week I have decided to just post the link to the post. CLICK HERE
This week I’m discussing Niche Marketing in healthcare.

Tags: healthcare marketing niche marketing Trusted MD

I’m having a bit of blogger’s guilt. I’ve been swamped lately and Driving In Traffic has fallen behind. Sorry…

What has been keeping me busy?

Well– last week we had the second meeting of the Atlanta Social Media Club hosted by Dan and Dave at Earthlink. There we had a great conversation on “What is a community?” and “What communities do you participate in and why?”

The next Social Media Club will be held at 6:30 on April 4th at the Earthlink headquarters. I will be moderating so stay tuned for the topics. Either way— come out and join us– snacks are on us!

Next– Podcamp Atlanta will be taking place next weekend. I’ll be attending because I’m hoping to begin to use Podcasting at work. But being the anal sort that I am– I’ve got to learn everything before venturing forth…

Lastly– on March 18th… there will be a blogger get together at 5 Seasons Brewing. See Toby’s post for more information. It will be a causal affair where all things bloggy and social media-y will be discussed. All are invited to have a post-St. Patricks brew with us.

I may not be posting… but my addiction continues. Who say’s blogging is for the socially inadept. As the numbers of events indicate… we socialize just fine!

Come join us… there is always room for one more!

Tags: Social Media Club Podcamp Atlanta Blogger Meet-up Atlanta events social media

Once again I will be participating in the Healthcare Blogging Summit to be held in Las Vegas on April 30th. Like the one in December, Dmitriy Kruglyak has gathered a number of thought leaders in the area and the agenda is packed with a lot of interesting discussions.

As a moderator for a panel on the use of blogs for medical and health education, the nice people at the Consumer Directed Health Care Conference have offered me a free pass for someone (not in my organization) who would like to attend.

Click here to see the conference agenda.

If you would like to go, drop me a line at carol{at}drivingintraffic[dot]com. I’ve only got one pass, so first come first served. However, I also can put you in for a discounted registration as well.

Tags:Healthcare Blogging Summit Consumer Directed Healthcare Conference Las Vegas

OMG! Linden Labs has been highlighted on the Today Show this morning. They created an avatar of Matt Lauer and toured 30 Rock.

I’ll include a link later, if I can find one. They usually put up a videocast on MSNBC after 11:00 AM eastern.

Tags: Second Life Today Show Matt Lauer

I just saw this You Tube Video by PharmedOut, an independent physician-run project funded through the Attorney General Consumer and Prescriber Education grant program. This Video interviews a gentleman who was previously an Eli Lilly Drug rep about is experience marketing olanzapine.

With my day job, working in psychiatry with a team that treats real patients, conducting and publishing clinical trials, and producing educational activities for psychiatric nurses and psychiatric clients, I have had considerable experience with drug reps, antipsychotics and pharmaceutical advisory boards. With that said, in my opinion, this gentlman does accurately discuss the marketing mentality of the company during the time he served. However, I am pretty dismayed and considerably annoyed at the subtle message that “all prescribers are idiots and will believe whatever Drug Reps tell them.”

Most prescribers know that drug representatives in the past had a pharmacy background. Now, drug representatives come mostly from a marketing or business background. Especially in the case of schizophrenia and bipolar disorder, where there still are a number of significant questions about what really goes wrong in the brain to create the diseases. We certainly understand the diseases better than 10 years ago, but we cannot claim to understand everything. So…. unless, I’m wrong– this lack of clinical background among most current drug representatives creates a serious scientific credibility problem when talking about advanced interpretations of information included in the package insert and clinical studies (like mechanisms of action for efficacy and adverse effects as well as the projected health impact of side-effects and management suggestions).

Many also understand that drug representatives are rewarded for the number of prescriptions filled in their territory for the agent they market. While not every Rep is soley focused on number of prescriptions, this “moving product” reward system places these individuals squarely in the “Extraordinarily Biased” bucket of individuals who have the potential to influence care.

So I think it is utterly rediculous to think that any clinician would adopt any behavior or prescribe any treatment based solely on what a drug rep said. Much less, continue to do so when it is not working or there is significant risk of hurting a patient.

Now– I realize that the case of this medication also involves some accusations of important side effect information being supressed and withheld. Honestly, I don’t take sides here.
However, clinical experience is a powerful force in the practice of doctors, nurses and other health professionals. There may not be ready explanation, but trends and patterns can be seen. Afterall, where there is smoke there is usually copious oxidation occuring and if left to continue there will soon be a fire. It has been the dogged determination of independent clinician researchers to understand the trends and patterns that have brought this issue to the forefront.

My emphasis has always been that patients have the ability and responsibility to become more active in the selection of their treatments. Part of being empowered is understanding the players in the game. Marketing of treatments to practitioners does play a role, as does, accurate interpretation of research findings, dissemination of those findings and clinical experience and knowledge of the practitioner. Patients should feel free to ask questions to make sure that the proper amount of consideration is given to all the voices.