General Discussion
In reply to the discussion: This message was self-deleted by its author [View all]MADem
(135,425 posts)The patient is allergic to an additive in the alternative; the alternative doesn't work as well on the patient, whatever....but if the doctor doesn't agree on the medical necessity, they won't go to bat just because a patient "likes" what they are on and doesn't want to switch to something new.
No formularies are more onerous than military medical ones--even for active duty people. The doctors generally will not go to bat to get a patient a med that is off the formulary without first trying the one(s) on it. But if it's obvious that the stuff ain't working, they WILL fold if the doctor insists. It's a pain in the ass but it can be done.
People who think single payer would "solve" this problem need to think again. What single payer is about is a minimum standard for ALL, not "every little optional or high end drug you want or need, when you want or need them."
The UK National Health doesn't hand out designer drugs or the high-end stuff as a first resort, either. Nor do they authorize cutting edge surgeries very easily, either. You have to "go private" for that. In fact there are parents who save/hold fundraisers to raise 40K pounds for specialty operations for children with cerebral palsy to be done in USA because they are not covered in the UK as a rule, and the few that are covered use an older system with a longer recovery time.