> I have a hard time reconciling what (little) I know about in the US medical system between insurance behavior, doctor choice, and ads aimed at patient choice.
As a patient, you don't get to choose what drugs a doctor prescribes to you. But you do get to choose (to an extent) your doctor. So if you ask a doctor about a particular prescription, and it's within the sphere of treatment options they would evaluate for you, then they'll usually give you that option. If for no other reason than to pacify you and prevent you from doctor shopping until one does give it to you.
To that end, medical marketing tends to work twofold: a salesforce focused on "educating" doctors on a particular medication, and patient advertising to get patients requesting it more. Doctors tend to have a go-to grab bag of treatment options they're familiar with and tend to prescribe, so both of these work to accelerate how quickly a particular new blockbuster gets its way onto that shortlist for any particular doctor.
Insurance companies, traditionally, operate as a backstop to prevent this from going overboard. Since they act as payor for both the physician and prescription, if they deny claims it can impede uptake. So they can put in place things like documentation requirements, prior authorization[1], and prescription formularies. That said, components of the Affordable Care Act (i.e. Obamacare) capped the profitability of insurance companies as a percentage of total revenue. Which doesn't really reconcile with trying to reign in costs, as runaway medical spending just means runaway premiums they can justify charging, and the absolute value of their percentage-based cap goes up.
As a patient, you don't get to choose what drugs a doctor prescribes to you. But you do get to choose (to an extent) your doctor. So if you ask a doctor about a particular prescription, and it's within the sphere of treatment options they would evaluate for you, then they'll usually give you that option. If for no other reason than to pacify you and prevent you from doctor shopping until one does give it to you.
To that end, medical marketing tends to work twofold: a salesforce focused on "educating" doctors on a particular medication, and patient advertising to get patients requesting it more. Doctors tend to have a go-to grab bag of treatment options they're familiar with and tend to prescribe, so both of these work to accelerate how quickly a particular new blockbuster gets its way onto that shortlist for any particular doctor.
Insurance companies, traditionally, operate as a backstop to prevent this from going overboard. Since they act as payor for both the physician and prescription, if they deny claims it can impede uptake. So they can put in place things like documentation requirements, prior authorization[1], and prescription formularies. That said, components of the Affordable Care Act (i.e. Obamacare) capped the profitability of insurance companies as a percentage of total revenue. Which doesn't really reconcile with trying to reign in costs, as runaway medical spending just means runaway premiums they can justify charging, and the absolute value of their percentage-based cap goes up.
[1] https://www.medicinenet.com/script/main/art.asp?articlekey=4...