Real Life Health Care Reform 2011
... my experiences 23 June 2011 ...

I live on disability benefits, and my sole insurance is Medicaid. I've been on a pharmaceutical drug for the past 3 years, and every month when the pills are almost gone, I go to the pharmacy for a refill. In the past, certain infrequent meds (as once per year) needing refills have required a physician approval, which is certainly understandable. About 3 weeks ago, I tried to get my regular prescription refilled and was told once per year it requires physician approval.

I asked why, if this is an annual requirement, it is the first time it's been requested. This retail scenario almost came to verbal blows. Feeling this particular pharmacy to be fully oblivious to the concept of good customer service, I've transferred all my meds to another pharmacy, who has also told me I need this annual physician's approval before Medicaid will approve the drug. The pharmacy has faxed their request to my doctor TWICE now; I've left voicemail with my doctor's nurse re the expediency of this matter, and had absolutely no response. Today I called the Medicaid office directly, explained the situation, and ended this just saying I want to know who's dropping the ball here, and whether ot not I should start looking for a lawyer.

So here's what happened: The reason this is the first time I've heard of Medicaid requiring annual physician approval for this particular drug (and I presume other drugs as well) is that it is directly related to our new health care plan. I completely understand this, as I'm sure there are some patients who continue receiving prescriptions long after they're needed for all sorts of reasons, and this type of approval cuts back on that type of abuse. But why is this the first I (the patient) have heard of this? Shouldn't there have been some sort of notification before I ran out of my meds?

The answer is NO. This is related to governmental issues on the other side of the Hill concerning budget cuts, which trickle down into situations such as this, where the monies for personnel and supplies (paper, postage, etc) are no longer available. In my individual case, waiting by habit as I do to not be concerned until it's time for a refill, means almost 3 weeks have passed and I'm operating on substitute meds I have on hand which may or may not be a help or a hindrance.

I have no way of knowing if my doctor's office has not fulfilled their part in this chain of command since they aren't returning my calls. However, if they also were not notified, it's probably quite a surprise to find they are to go to the Medicaid website, download, complete, and fax the required form to the Medicaid office, before the Medicaid office can approve the refill with the pharmacist. My Big Picture query now is that if the Federal budget cuts don't allow for personnel and paperwork, does the office of the physician have the same dilemna, which may explain why they haven't contacted me (seeing as to how I'm probably not their only patient with this problem).

To the Feds, I have the answer here (but who listens to me, right?). States across the country have work programs required of persons requesting federal financial assistance, and while these programs will supply additional needs required of person seeking employment (such as child care, presentable clothing, transportation, etc), it's often really a big waste when self-supporting jobs in some areas just aren't there. My solution is to allow those recipients who are unable to find employment at the moment to to be able to exchange work program requirements for volunteering in areas being cut (such as Medicaid). They still receive government monies, and the government gets the extra workforce power they obviously desperately need.

To my own feelings, I have to say after this past winter's bout with pneumonia and hospitals and massive amounts of pharmaceuticals, the biggest problem I can see in the health care field right now is their general lack of customer service. People hospitalized, people with regular doctor visits, people trying to get a prescription refilled at the pharmacy, are just NOT the same as a customer trying to choose which cologne to buy at Walmart. We are sick, our bodies are being affected in ways we sometimes can't identify by the drugs you are giving us, and when we complain, or try to ask why, we're labeled “a difficult patient”. Improving the quality of health care, IMO, should start with the attitudes of the health care professionals toward their patients, from the surgeon to the pharmacy assistant. (or get out of health care and behind the counter at McD's)

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