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Comment by IG_Semmelweiss | Hacker News Reader

Its not just presciptions. Its eligibility , claim submission, prescriptions, etc.

This is really affecting doctors and patients. Patients are not getting the drugs they need or the authorization for a critical procedure. Doctors' cash flow is interrupted.

A lot of admin workers are backed up, and that itself is leading to problems too.

Why the backup? Its not just electronic data exchange being offline. Its that everything is now "going to paper" (submitted hard copy) which requires humans. Those humans used to take care of the actual work. Now they are stuck shlepping paper from A to B instead.

I submitted two links explaining this in more detail yesterday

https://news.ycombinator.com/item?id=39561697

View on HN

Sometimes this kind of event is the trigger to design a more human-efficient process.

For example, if it goes on longer, the FDA might allow the majority of drugs to be sold directly on online marketplaces like Amazon without a prescription. That would remove a huge amount of paperwork and doctors appointments for a massive number of people.

Let's be honest, the majority of prescription drugs don't have an abuse risk.

Nah. We wont even allow people to import drugs from canada. Meanwhile, canadians are the nicest, most honest people you will meet.

You have a positive outlook and that deserves kudos, but its not going to happen, at least in relation to the current fiasco.

The pharmacy lobby is too strong.

> We wont even allow people to import drugs from canada.

This seems false based on countless anecdotal experiences and various sources online [1]. Individuals with a valid prescription can have that (once issued by a Canadian/provincial licensed professional) filed and bring it with them or have it shipped through online marketplaces that integrate most of these steps.

Suppliers importing from other countries seems to still be illegal although Florida seems to have recently passed a law and received FDA authorization to do this for some drugs [2].

[1]: https://www.singlecare.com/blog/ordering-medications-from-ca...

[2]: https://www.kff.org/policy-watch/what-to-know-about-the-fdas...

There might be some risk with idiots taking z packs for colds and creating more super bugs but there's definitely less stupid ways of doing this.

People who take critical stuff regularly usually have to ration drugs so they have a store in case of emergencies. If you travel somewhere and you forget your life saving drugs you then have to spend a good chunk of your trip grovelling to the pharmacist and doctor (depending on the drug) to get an emergency refill if the drug is even available in that location. The whole system is bonkers.

i have to do this rationing, i skip a dose a couple times a month to slowly build up a reserve, it came in handy on multiple occasions where insurance was holding up meds.

"Let's be honest, the majority of prescription drugs don't have an abuse risk."

It is absolutely disgusting, that you need a prescription for pharmacy items. There is nothing better than going into a pharmacy and just being able to buy what you need. Never had any problems in Colombia, Brazil, Russia and rarely in China.

What about people without health insurance?

  > What about people without health insurance?

Are you suggesting that these people do not see doctors and self-diagnose? I could see an argument that making the drugs OTC without prescription may do this population more harm than good.

That's a good point, but honestly I don't know what the net effect would be.

Remember that in the US, drug companies market to patients, even though it's the doctor that must prescribe the medication. In other countries, this is illegal.

Maybe the barrier of a doctor's visit is not so relevant. Or, maybe it's what prevents things from becoming completely unhinged...

> in the US, drug companies market to patients

Really? Why?

In some sense, they are a company like any other, why restrict their ability to advertise?

Then again, its not exactly good intentions that got us here.

Opioid epidemic

In the US there is advertisement for drugs. You have symptoms XYZ? You might have disease A. We can help. Talk to your doctor for medication B.

In many countries, this is forbidden.

It's easier to say "talk to your doctor about X" than get attractive pharmaceutical sales reps to convince doctors about the same drug's efficacy with a pamphlet.

There's a gradient. There's definitely a number of things that are prescription only for... unknown reasons. My low dose statin requires a prescription, even though I can get roughly 4 months worth of it at a time. Even its side effects are not extreme. But it forces me to interact with my doctor occasionally just to get a repeat.

"Are you suggesting that these people do not see doctors and self-diagnose? "

Ah. Yes. What is the alternative if you can't afford a doctor?

" I could see an argument that making the drugs OTC without prescription may do this population more harm than good."

Please die for the greater good. I pass.

I have no idea what other people need. Beta blocker? Metformin? For a start, I would like to have every cortisone based product (cream, tablets) OTC and antibotics too.

In some countries, you can't even buy an antibiotic cream or hydrocortisone cream OTC. In Brazil, I was damn happy that once I could get antibiotic eye drops and once an antibiotic for the ear (drops).

Hey, in many countries you can even buy Viagra OTC. A buddy asked me to bring some for him from abroad.

> Are you suggesting that these people do not see doctors and self-diagnose?

Yes! Over-regulation cost lives. See Canada, people dying because can't see doctors. Most of prescription drugs are gatekeeper for no reason, they are not 'drugs' there is no reason for that.

Meanwhile typical Montreal health-care interaction:

1. Call your doctor - next appointment in 1-3-6 month

2. Wait till it get bad enough, go to emergency room.

3. Wait and cry there for 6-12 hours, get morphine, see a specialist, get a prescription, go home.

Since my conditions are chronical I should be able to get my meds easily, but nooooo, let's gatekeep everything and make people suffer and die.

See https://globalnews.ca/news/10148872/quebec-er-patients-death... for proofs.

This is what Mexico does, and it works fine.

There are no prescriptions in Mexico.

Medications which are scheduled controlled substances (amphetamines, codiene, morphine, etc) are sold directly by hospitals. There really aren't many of these, and hospitals already have to stock most of them for surgical use.

Everything else is cash over the counter.

And pseudoephedrine is illegal because of pressure from the US.

I'm glad pseudoephedrine is legal where I live. Once in a blue moon, if I need it, I can get it.

Is it illegal in Mexico because meth comes from there in significant quantities?

It's illegal in Mexico because the US put pressure on them.

The US said "you need to stop selling this without a prescription system". So Mexico stopped selling it entirely.

That's crazy. I can but it over the counter without a prescription.

Not without showing ID, you can't. And the ID tracking system is part of the prescription system, even though there's no doctor involved.

It's why you can only buy pseudoephedrine from pharmacists.

What about drugs that can have harmful interactions with a person's other health conditions or other drugs that they are taking? A big part of the role doctors and pharmacists in the prescribing process is to guard against this. Are ordinary, non-medically qualified people really supposed to navigate this on their own?

Ordinary people can and do in many places. Pharmacies can still employ pharmacists who will advise you or ask questions if you’re something risky that may interact with others. You can always check with a doctor before hand. Most medicines don’t have significant interactions and those that do you will usually be warned to check about by both doctors and pharmacists.

A lot of “safety” concerns is just FUD spread by a system that wants to preserve itself.

If you have humans in the loop, they're going to make mistakes. Pharmacists and doctors also have bad days and forget things. People are their own best advocates and caretakers.

If there's a database with contraindicators, make it public, let people search it, require packaging to inform the public to search the database for contraindicators for their own safety before taking the drug. If people are really unsure, they can decide to engage a doctor or pharmacist instead of being forced to engage a doctor or pharmacist.

Doctors are navigating interactions in large parts by database lookups anyway - there are websites where you enter drugs and get a list of possible interactions. Those could be made available to patients too (the one I saw a doctor in my family using is provided by some medical website and softly gated "for doctors use only").

Natural selection will eventually handle the crowd of people who take random drugs without considering possible interactions.

Hardware stores also sell many things that will kill you if used incorrectly. We can't have the world revolve around the least capable of us, it's holding everyone back.

If doctors and pharmacists were effective in preventing all adverse interactions, we wouldn’t have those “don’t take ADVERTIX if…” disclaimers in US drug ads.

Are prescriptions required for antibiotics?

Nope.

And the world has not imploded.

There's a lot of chicken-little-ism around the prescription system

Yea, this screams multi drug resistant infections.

there is a system diagram of roles; this system serves several purposes at once, some of the roles accelerate or benefit from, different purposes; there is so much money involved that the money becomes a driver aside from intended purposes.

The system is being attacked / interfered with, almost certainly over the money parts.

Patients using the product are by definition not reliable for self-prescribing (argue against this all you want, there is a lot there)

Specialization has risen profoundly in the digital age. Even full time MD's do not know all the aspects of the prescriptions; even full time pharmacists do not know all the medical case context; patients know almost none of this as a whole, though the have intense incentives to think they do, or try to, to varying degrees of success.

A suggestion of "just let the markets and customers work it out" is unwise at the least, and certainly will bring unintended consequences. The current system is overly gamed and now failing outright. What to do? just describing a problem space here..

> Its that everything is now "going to paper"

Is it wrong of me to hope it stays that way?

Yes, frankly. It results in terrible outcomes for basically everyone, which ultimately hurts patients the most.

Does it? My impression is that going paperless actually made doctors stop doing medicine and start spending 90% of visit time doing bullshit e-paperwork.

(Yes, I know it's not bullshit - it's so that right insurers get billed. The most important part of medical art.)

Brief summary of the situation (as of 3/1)

Impacted services:

-Electronic Prescriptions -Several Patient Record Sharing (PRS) systens -Claim Submission -Prior Authorization Appeals -Almost everything involving Fax + UHC

Restored services:

-Electornic Prior Authorizations (ePA) submissions -Real-time benefit checks

We are launching drop-in replacements for their APIs: https://www.stedi.com/blog/replacements-for-change-healthcar...

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