I found myself chatting with a pharmaceutical sales representative the other day.
My wife and I hosted a BBQ in our backyard and the sales representative was one of our guests. I learned her occupation over a couple of beers as we huddled around the BBQ for warmth on this uncharacteristically chilly evening.
I had some fun asking about the drugs old guys like me might have an interest in. My e-mail junk folder is filled with unsolicited advertisements for medications that enhance male libido. I learned that Cialis can have fun benefits for those who are not yet experiencing erectile dysfunction!
Our discussion became more serious when I asked about medications to assist those of my clients with chronic pain and depression. The two are quite clearly linked, and effective treatment requires attacking both the pain as well as the depression.
Chronic pain can, quite obviously, lead people to experience low mood. Just think about how a toothache or headache can ruin your day. Imagine suffering that pain day in, day out; week after week; month after month; year after year.
In true “chicken and egg” fashion, depression can also be a factor in the development of a chronic pain condition, and in how much of an impact that chronic pain will have on function.
The sales rep told me about medication that is specifically designed to treat both low mood as well as chronic pain. That’s not typical. Typically, there are medications that treat depression and other medications that treat pain.
When I asked about the availability of such medication, the sales rep told me that they are very expensive.
I envision pharmaceutical sales reps making sales pitches to doctors, trying to convince them to prescribe expensive new medications. Doctors would quite reasonably be cautious about introducing expensive new medications.
From my perspective as a personal injury lawyer struggling to facilitate as full a recovery for my clients as I can possibly facilitate, I want my clients to have access to whatever medications might be available, regardless of expense.
Expense is not a concern for me because the offending driver who caused the problem paid liability insurance premiums to ensure that the insurance company will step up to the plate to pay whatever is necessary for the innocent victim’s medication and other needs.
That’s what liability insurance is all about.
Some medical plans will cover certain, less expensive medications, and not others. The Pharmacare program is probably even more restrictive.
There are no such restrictions when considering fair compensation for an injury victim’s injuries. If your doctor prescribes an expensive medication as the best option to treat your injuries, the insurance company will definitely have to reimburse you.
Incidentally, this applies to libido enhancers as well. Pain and headaches do a number on a couple’s sexual relationship. The loss of sexual intimacy can be destructive to the relationship dynamic. It can be very reasonable to bring medication into play to cause an increased libido that breaks through the pain barriers and restores that intimacy. That’s a whole other topic I’ll deal with in another column.
I am not saying that we should be reckless with spending money on crash victims. I am saying that we should be fair. If you are sitting at a red light and someone smashes into the back of your car causing you injury, fairness says that the negligent driver’s liability insurance should pay any reasonably incurred expense to help with your recovery and to minimize the impact those injuries have on your life.
This applies to therapies as well. Ignore the ridiculous up-front payment policies that the insurance company might have. They have policies with no medical basis that, for example, limit massage therapy funding to the first couple months after the crash. I also regularly hear that they refuse to fund both of physiotherapy and chiropractic care, pushing you to choose one or the other. That makes zero medical sense.
What the insurance company might choose to pay for up front should not have any impact on your medical care. Your medical care should be determined by your doctor and the therapists to whom you are referred.
I don’t know how you can get access to expensive new medications that your doctor may be reluctant to prescribe because of expense. I encourage you to be clear with your doctor that achieving as full a recovery, with as limited an ongoing impact on your life as possible, is your goal, and that you will pay whatever it takes to get there.
You can feel confident about the reality that the insurance company will end up reimbursing you every cent you spend pursuing that goal.
Published June 30, 2011 in the Kelowna Capital News
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