Average Wholesale Price (AWP) is often referred to as the wholesale price of medications.
That said, I do not use this platform to complain. It is just not right to do. I have always been of the thought that complaining does not do anything to help the situation and if you do not do anything to fix it, you are just complaining. I’m here to state the facts. Here’s the deal, sometimes a person needs medication and medications have a purpose but due to the changing environment of the insurance world medications are getting more and more difficult to obtain because of cost. This is the old “which came first, the chicken or the egg?” dilemma. Some might say that pharmaceutical companies are raising their prices but for everyone that says that some are also blaming the insurance companies for increasing deductibles and formulary tiers. That’s just one side that you, the patient, sees and we are very empathetic about it. I’m here to shed some light on what we are going through in the office when I prescribe a medication.
When I choose to prescribe a medication it is because it is what is indicated by the condition presented in front of me. We have electronic prescribing so it is immediately transmitted to the pharmacy to help get efficient fulfillment of your medication. During this transaction, your insurance (if applicable) will be verified and if it is covered you are told what your copay will be depending on what tier it falls. However, if you have an deductible that has not been met then, just like any insurance, you are subjected to whatever the cost will be out of pocket. We usually get a phone for this and I am usually asked to change the medication, of course, to my second choice (which is called my ‘second choice’ for a reason). If your insurance decides it needs further justification they may ask for us to complete a prior authorization (PA) –which is simply another hoop to jump through, that we do because we want you to get your medications. Often times it is unnecessary, it will come back with a statement that the medication I thought was best for you initially is now being requested by the insurance company (who has not evaluated you–but asked for your diagnosis) thinks that the other medication would be better for you. In the end who wins? The better question is who loses?
Just to recap:
- the patient does not have their medication OR the patient has decided to just pay for it
- the doctor has now had to succumb to the forces of the insurance company to save the patient from the above happening
- time has now passed that may have allowed the condition to exacerbate
- resources have been used, office staff, patient time in called both pharmacy and office, sometimes the insurance
What if you knew the AWP??? What if the AWP was less or minimally more than your copay? What if you were able to obtain the medication I prescribed, what I thought was best for you, immediately without having to deal with the difficulties described above?