Within the past year we have seen the continuous rising prices in the pharmaceutical industry, with the EpiPen crisis and the price of insulin increasing. Both lifesaving drugs, are harder for normal patients to afford. Recently, studies have discovered a new drug that contends to cholesterol, and can overall reduce the risk of heart attacks and deaths. The development of the drug has come to a halt for a period of time while researchers figured out what the actual benefits of the drug are for the high risk patients. In the meantime, while there are still proven benefits, the insurance companies are not ready to approve the drugs. Meaning that the patients that are currently seeking out the drug for their condition are paying more out of pocket due to the insurers not approving and covering the cost of the drug. This is making the drug both harder and more expensive to obtain. It costs approximately $14,000 a year. Once they see that the drugs are working in the patients, they will submit an authorization. Some of the patients have to meet a specific criteria to appeal for the drug. In the meantime, patients that are in dire need of the drug are expected to wait.
We can view this situation in the eyes of Bayles, who wrote a piece on professional client relationship and the different models that represented these relationships. In the context of the article, I believe that the doctors are representing the fiduciary model. Bayles describes the fiduciary model as the professional acquires the decision making authority, and acts in the best manner for the client. By recommending the drug to the patients is giving them the best option. Some of the doctors over exhausted themselves working with the insurers to approve the drug for their patients. Overall, I feel like the doctors have the patients best interest, and want to the acquire all the benefits of the drug at an affordable price. In the relationship between the insurers and doctors, the insurer has more power in decision making and whether to approve the drug or not. This would represent a paternalistic relationship, and this is described as simply as the professional controls the decision making authority.
So… what do you think that the insurance companies should do? Are THEY looking out for the best interest of patients in dire need of this drug.