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How CVS Dealt a Blow to Physician Autonomy


The retail pharmacy chain recently replaced an established drug with a replacement. It's a move that, in one doctor's opinion, usurps physician autonomy.

Recently, a press release from CVS, one of the nation's largest retail and pharmacy benefit managers, caught my eye. In the release, CVS removed 35 medications from its standard formulary in favor of other less expensive agents. One of these drugs removed was the original basal insulin, Lantus, a standard of both Type 1 and Type 2 diabetic regimens for the last 20 years.

Lantus was replaced with a recently approved, "follow on biologic", Basaglar, that will not be released for use until Dec. 15, 2016. So, an established medication with a narrow therapeutic index, used to treat diabetes will be substituted for by a biosimilar medication without any post clinical trial experience to save money.

As physicians, our job is to provide the absolute best care for our patients. Our code of professionalism, requires us to consider the patient's medical needs above all others. Since providers are the only group with the license to prescribe medications, we must push back against this blatant attempt to take away our right to prescribe an established agent with a medication with unknown potential consequences.

We have all substituted generics for brand name medications because of cost. We've also all switched from one brand to another because of its favorable tier on the pharmacy list. That is not the case here. The difference in this case is that the new drug, Basaglar, has not even appeared on the market, so there is no clinical experience with this similar but not identical medication.

To me, this decision by CVS to replace Lantus with Basaglar, represents the final straw in usurping the physician's autonomy and authority. Before the majority of clinicians in the U.S. have even tried this new medication, physicians and patients have been told this drug is interchangeable by CVS. Physicians bear the responsibility for the decision making so we should have the authority to make these crucial treatment decisions with our patients. Our patient's health depends upon our knowledge and experience when prescribing, we should not allow CVS or anyone else to take that away from us.

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