To err is human. To really screw things up, you need government.
One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.
Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and insulins are brand name didn’t reach the decision makers. Unsurprisingly, taking everyone off of their asthma and diabetes medications from June to September didn’t reduce overall costs. ER visits tend to be expensive. That rule is now removed.
Starting in January, every Medicaid recipient who is not a child, HIV positive or insane will be limited to 5 prescriptions monthly. The state will pay for up to a 90 day supply of any non-classed medication. For patients who are currently taking more than 5 prescriptions, the state is recommending staggering the prescriptions, as in fill 5 in January, 5 in February, and 5 in March to total 15 prescriptions.
For classed medications, the DEA requires monthly prescriptions. Most pain management patients receive between 2 and 3 classed medications monthly. This means that for the Medicaid population who take narcotics, their total prescription budget for the quarter is reduced by a factor of 3 for each classed medication.
To add more to my staff burden, the state requires a PA for almost every medication, including generic medications that are on the Walmart $4 list. This year, they reduced the maximum duration of the PA from 6 months to 2 months, thus ensuring that my staff will need to fill out pages of useless paperwork for every Medicaid patient.
I can’t see how this saves money. The state has to process every paper that I generate. No bureaucratic savings. The patients will of course fill the classed medications first, leaving off medications like blood pressure and diabetic medications. They will again wind up in the ER. No savings there. The entire setup appears to be for the sole purpose of punishing doctors and patients for requiring bureaucrats to work.
There is only one reason why I still accept Medicaid. That reason is that in my state, my prescriptions will not be honored by Medicaid unless I am a Medicaid physician. My Medicaid patients can’t pay cash for their medications. If the rules from Medicaid change to the point that I can’t get my patients the prescriptions that they need even if I am a Medicaid physician, I’m done.
“Tiredoc” is a physician.
