DEAR DR. ROACH: My insurance company has suddenly instituted all kinds of new rules that require me to get preapprovals for medications (including seizure medicines) that I have been taking for years. I didn’t find out until I tried to renew my medicine, and now I may run out. Why are they doing this? Isn’t it dangerous? — D.M.

ANSWER: In my opinion, it is dangerous. Studies have shown that requiring a preapproval for a medication that a person is already on increases the odds of it being discontinued sevenfold. It also delays the prescription from being filled by an average of 10 days.

This is great news for insurance companies since they do not have to pay as much for your prescriptions. It isn’t good for you because you might be unable to get medicine that has been useful for you (and critically important, such as anti-seizure medication) in a timely fashion — or sometimes at all. I have seen companies repeatedly refuse to pay for medicines that I thought were necessary and only cost $20 without insurance.

Other studies have noted that making it easier to get prescriptions increases drug costs but reduces patient morbidity and mortality. There is also the cost of the patient not getting the drug; for example, the cost of a hospital admission for intractable seizures is much greater than paying for a patient’s necessary seizure medicine.

In my opinion, the efforts toward making it harder for physicians to prescribe medications (and patients to receive their medications) has the potential to decrease spending in the short run, but it may actually increase costs over time and lead to worse outcomes for patients.

DEAR DR. ROACH: I see ads for bathroom smart scales that claim to provide useful information that a regular scale does not. Are they accurate? Should I be getting one? I am pretty happy with my health. — R.C.

ANSWER: A smart scale is a device that measures several important body conditions. In addition to weight, they may estimate body fat and lean mass. Some also purport to measure bone density. These devices typically send information to an app on your smartphone, which might bring up the concern of privacy. Most experts think that your personal health information is likely to be safe.

The accuracy of these scales, which range in price from about $20 to $150, is very good for meausring weight and is usually very close to hospital scales. However, the methodology used to estimate body fat percentage is not as accurate as a clinical tool like a dual-energy X-ray (DEXA) scan. This leads to an average error of up to 4.5 kilograms of fat mass, making them of very limited usefulness. These devices were found to underestimate fat mass in one study that included three devices.

Still, weekly weighing with a smart scale was found to be helpful in people who are trying to lose weight. Having an accurate and up-to-date weight can also help your medical professional tailor advice for you. If you aren’t trying to lose weight and are generally healthy, a smart scale isn’t particularly helpful.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc.

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