A step backwards

My health insurance this year (or at least until my COBRA benefits run out) switched to Aetna from Cigna. Benefits and co-pays, including the three-tiered drug formulary, basically are the same, and my regular internist is in both PPO networks. Both use mail-order pharmacies for maintenance medications and both require paper forms for initial prescriptions (though refills can be ordered online).

I placed my first drug order with Aetna Thursday.

The Aetna and Cigna order forms are pretty similar, with one glaring exception. While the Aetna form has the standard check boxes for patients to list allergies and chronic conditions, it does not ask about other medications. There was no place to list the fact that I take the formerly prescription-only but now over-the-counter Claritin-D for hay fever, nor could I mention that I’m still taking anti-malarial pills for 12 more days because I recently returned from West Africa. I had to go with doxycycline, which must be taken for 28 days after leaving a malarious area, because of a potential drug-drug interaction I might have had if I had taken the more potent Lariam (mefloquine).

For that matter, nowhere on the order form could I even mention the hay fever, as there was no “other” category for allergies. I wrote it in anyway.

The place that prescribed the doxycycline, Northwestern Memorial Hospital‘s travel immunization clinic, had online interaction checking to go with its computerized order entry. I’m sure Aetna’s pharmacists run all the checks, too, but they can’t check what they don’t know. A less-informed patient, e.g., someone who does not write about patient safety for a living, might not think to provide such information.

It boggles the mind to think about how many serious drug interactions might occur because a major pharmacy operation doesn’t ask about OTC and herbal remedies.