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Comment by bshep | Hacker News Reader

The pharmacies issue is a constant problem: patient lives out of town so prescription is sent to his home pharmacy at his request, on the day of discharge he realized his pharmacy is closed and wants them sent to a local pharmacy, of course this always happens at 5pm when you are driving in traffic, the patient is angry because they want to leave but there is not much you can do. This happens very frequently, doesnt matter if you ask ahead of time for the patient to confirm the pharmacy, something inevitably happens.

The other issue is peer to peers and prior authorizations, these take up a significant amount of time and are essentially ways the insurance companies put barriers to care and reduce their costs.

I think some of your ideas could work but good luck getting anything past the politicians, some of these things would be expensive and others would be unpopular to those that donate to the politicians.

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For your first example, wouldn't the friction be reduced just by telling patients the business hours of the pharmacies nearby? I hate how this question is always posed, as if I'm supposed to come up with a name and address out of a hat. If it's the middle of the night or Christmas Eve and I'm trying to get medicine for the baby, the provider probably has a better intuition than myself as to which pharmacy will actually serve me. If I ask explicitly, the provider is usually happy to suggest some options. Even a simple web interface listing hours of operation would be better than the current method, where the patient is expected to pick a pharmacy from memory before they even know what medicine they need or how long it will be before they are discharged.

This setup is crazy, as someone from another country.

Why don't you have a unified system for the pharmacies and doctors to tap into?

In my country, if I get a prescription it goes into my card. Then any pharmacy can read the card, see what prescriptions are yet not used, and provide the product (which marks the prescription as covered). Recurring products, like allergy medication or chronic illnesses, become automatically available again after a certain time, like a cooldown. You only need doctor intervention during the original diagnosis and prescription, or after rare issues (like needing an extra prescription because you lost the meds).

I'd have thought this system or a very similar one is universal.

We used to! Doctor would write prescription on a pad, and you could take the script to any pharmacy.

Of course, doctor penmanship is terrible, and we're going paperless, so we've got to digitize. And every doctor's office and every pharmacy has their own system, and sometimes they can talk (but I think there's a lot of faxing behind the scenes)

Of course, you can't know what drugs will be covered, so the doctor has to guess, and if they guess wrong, the pharamacist will want to check with the doctor to see if something else is OK to save you money, but nobody can be reached, ever.

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