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Call for Action Investigation: Prescription Payoffs

She's been happy taking the brand name drug, Lipitor for seven years.

This woman we'll call Pam, says she tried cheaper, generics three years ago, but they didn't lower her cholesterol the way Lipitor does.

That's why she was surprised by a call out of the blue from her pharmacist... trying to get her to change from Lipitor to a cheaper generic.

Pam says, "She never really gave me a choice in the matter. She kept falling back on the fact that the doctor had approved the prescription. It was kind of a done deal already."

But it wasn't a done deal. Pam learned the pharmacist went over her head... contacting Humana, her insurance company and her doctor, before calling her, the patient.

Pam points out, "I'm the consumer. I was left out of the loop. If you're doing someting in someone's best interest, you should be included."

Pam says she didn't understand why the pharmacist would initiate such a move until Safeway gave her this Tip sheet from a company called Outcomes Pharmaceutical Health Care.

She says the suggestion sheet contained a bombshell... explaining that it pays pharmacies like Safeway if they can get patients to switch from brand name drugs to generics.

Pam says, "She got a $20 payoff for the pharmacy if they initiated a change from Lipitor to Simvastatin or Pravastatin and I was very appalled at this because I felt like I had been kind of "sold." It wasn't about me at this point. It was about the money they might get as a pharmacy."

Outcomes' chief operating officer told me it has 40 clients nationwide, including major insurance companies like Humana and Blue Cross, Blue Shield.

C.O.O. Patty Kumbera says Outcomes' goal isn't just to get patients to switch from brand names to generics, but to make sure patients' needs are being met, addressing gaps, and cuting back on medication waste.

She says the Tip sheet specifically states the patient should be contacted first. She apologized that directions weren't followed in Pam's case and said those involved need to be re-educated.

I talked to staff at Pam's doctor's office and was told they were shocked to hear about the bonus payments to pharmacies. They say people have the mistaken idea that doctors get kickbacks, but strict laws keep them from favoring and prescribing one drug over another.

They've notified Humana that Pam's physician only wants her taking Lipitor.

A Safeway spokeswoman tells me Pam's case wasn't handled properly and she apologized.

When I asked about the bonus payments from Outcomes, I was told the money goes to Safeway not the individual pharmacists. And for competitive reasons she wouldn't tell me how much they make on such incentives.

Pam says she has nothing against generics and knows they are cheaper and better in some cases.

She just wants everyone to know about these medication relationships.

Humana refused to talk with us about this story. Pam tells us that Humana called her, but never explained why it shared her personal medical information with a third party company like Outcomes, without asking her first.

Pam says a Humana rep apologized and made a note in her file, saying it wouldn't happen again.


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