medicine, drop size, and vampire blood

[cellio]

A recent mailing from my employer's department of reducing health-insurance costs (that's probably not their real name) offered some advice that seemed questionable to me. They suggested splitting pills -- not, they hastened to point out, that we should take half the dosage we need, but rather, we should get pills that are twice as strong as they need to be and then split them. They suggested that a stronger drug doesn't necessarily cost any (or much) more to fill, so you can fill your prescription half as often, saving you half the copay and them a lot on the balance. (Aside: what bright person decided that your cost, if insured, should be per month rather than per some volume? If I take a medicine twice as often as you do, why shouldn't I pay twice as much for it?)

I wonder how the pill-splitting scheme could actually be implemented legally and what doctor or pharmacist would go along with it. I find it hard to believe that a large company would advise its employees to commit insurance fraud (in a manner that's traceable), so there must be a way to do it, but I'm puzzled. (The company self-insures; maybe that's why it's ok?)

I was telling this to Dani last night, and commented that even if it's kosher I can't benefit from it for my prescriptions -- the medicine I take for glaucoma is in the form of eyedrops, and I don't know how to get double-sized drops. (Nor am I going to ask my ophthamologist to write a bogus prescription.) This, combined with some recent TV viewing, led us to wonder how big a drop is, anyway. We didn't have an internet connection to hand; Dani tried to work it out theoretically while I tried to work it out empirically. (Things often fall out that way with us.) A medicine that I take once a day (two drops) comes in a 2.5ml bottle and lasts about a month (maybe a little more). Viscosity matters, of course; this stuff is closer to water than to syrup. So I posited about 25 drops/ml for my medicine. (Google later suggested 20 drops/ml of water as an approximation.)

And that's when we turned our attention to the amount by which a character in the True Blood episode we'd just watched overdosed. The character had a quarter-ounce vial of an illegal substance (vampire blood) that he was supposed to take one drop of at a time. Wikipedia tells me that the viscosity of normal blood is about three times that of water. It has no data on vampire blood. Assuming (and I don't know if that's valid) that drop size is directly correlated with viscosity, this suggests that the character overdosed by a factor of approximately 46. Ouch. :-) (Yes, it did hurt.)

Ok, fine -- what have you done with your science education lately? :-)

Comments

[hlinspjalda.livejournal.com]

The insurer seems to make the call based on the frequency per month that one takes the medication; that is, a maximum of X dosages per month is covered. We have direct experience of this situation with two of the classes of medication Mr. Fixer takes. In both cases it's the prescribers initiating the change of prescription. They know from experience (and we have learned too) that the insurance company will throw a big hissy fit and not cover it if the prescribers write the prescriptions the way that is most correct for Mr. Fixer the individual.

There have not been any delivery issues with these particular medications, i.e., no harm is done by splitting the larger pills and taking them by halves, and the dosage he takes winds up being the correct one. Obviously, for some medications and delivery systems this would not be the case.

So I guess if you want to look at it that way, the prescribers are conspiring with the patients against the insurance companies in order to get the patients the health care the prescribers say they need. Or is it simply gaming the system? From our perspective here on the inside of that situation, it's pretty damned frustrating and ugly that the insurance company takes 12.5% of Mr. Fixer's gross annual income every year and then counts beans with his medications.

*shakes self* Sorry. Button.

[cellio]

No need to apologize. The health-insurance games have been degenerating. :-(