by Daniel Nardini
A very good friend is having serious trouble getting his medications through Illinois Medicaid. One day, he went to a CVS pharmacy to pick up his usual prescription. You can imagine the shock on his face when he was told that due to the fact he had used up his allotment of four prescription medications for the month, he was being charged $325 for the medication instead of the usual $2! According to the pharmacist, by Illinois law, Medicaid will only cover the cost of four prescription medications per month. Anything over that amount of medications and the person on any additional medications will have to cover the costs by themselves. “But that can add up to hundreds and even thousands of dollars per month!” my friend said to the pharmacist. At that point there was nothing the pharmacist could do, and my friend had to leave the store without his medication.
The very next day he called his doctor and explained the situation. However, the doctor explained that the only way they could handle this was to send their authorization to Illinois Medicaid to explain this patient was on nine medications and why he needed them. As for the specific medication my friend needed, he would have to wait another day for the doctor’s clinic to try and get him free sample medications to cover for the month. My friend had run out of that medication the day before, and if Illinois Medicaid had covered his prescription he would not be in this current mess. So he had to do without one of the medications he needed for a day and a half. He was very, very concerned that he might fall ill and have to be rushed to the emergency room of a hospital. Fortunately this did not happen. Two days after he could not get his prescription medications, he was able to obtain the free samples promised him by the doctor’s clinic.
But he is not out of the woods yet. Because Illinois Medicaid needs special authorization from a doctor or doctors for any one individual who is on more than four prescription medications, my friend’s doctor had to prioritize all of the medications he needs and why he needs them. My friend was told by the CVS pharmacist that before this change came into effect, Illinois Medicaid did not limit the number of prescription medications for those covered by Medicaid. Then a limit of eight medications per month for those on Medicaid was set by the State of Illinois, and now four medications per month. Apparently, some politicians have become the new arbiters in who should and who should not get life-saving medications instead of the doctors who know what their patients need. I was told by one political pundit that this is a cost-saving scheme to save the state, which is already broke, some money.
How is this exactly saving money? If patients on Medicaid are denied or forced to pay out-of-pocket expenses for medications they desperately need but could not afford outside of Medicaid, then these same people may be forced to seek further hospitalization or worse this could force them to go without the medications they need—leading to chronic illness, injury or even death. Is rationing Medicaid really a wise idea? My friend is only one of an estimated 500,000 to 750,000 now on Illinois Medicaid. The Affordable Care Act expanded the number of those who qualify for Medicaid now, and the costs for how this will work still has yet to be worked out. However, a growing number of those on Medicaid, including my friend, have discovered the limits of what Medicaid will do for them. In too many ways, they are being told to ration their Medicaid benefits to help save money. But that savings is an illusion if those on Medicaid are forced to either go without their medications, forced into greater hospitalization, or have to do without their medications waiting for something terrible to happen to them.
Meanwhile, the politicians in Springfield do not have to worry about their medical care, do not have to worry about any limits for receiving medications if they need them, do not have to worry about either paying for medications or food and utilities that those on Medicaid may worry about, and do not have to worry about hospitalization. Of course, I can safely say the politicians do not have to worry about putting food on the table, do not have to worry about their utilities being paid for or bills that cannot be paid. And these are the same people who are determining what limits those within Medicaid should and should not get. This is just one more example why today’s politicians and the people could not be further apart—a divide as great as the Grand Canyon.
Rationing Medicaid
by Daniel Nardini
A very good friend is having serious trouble getting his medications through Illinois Medicaid. One day, he went to a CVS pharmacy to pick up his usual prescription. You can imagine the shock on his face when he was told that due to the fact he had used up his allotment of four prescription medications for the month, he was being charged $325 for the medication instead of the usual $2! According to the pharmacist, by Illinois law, Medicaid will only cover the cost of four prescription medications per month. Anything over that amount of medications and the person on any additional medications will have to cover the costs by themselves. “But that can add up to hundreds and even thousands of dollars per month!” my friend said to the pharmacist. At that point there was nothing the pharmacist could do, and my friend had to leave the store without his medication.
The very next day he called his doctor and explained the situation. However, the doctor explained that the only way they could handle this was to send their authorization to Illinois Medicaid to explain this patient was on nine medications and why he needed them. As for the specific medication my friend needed, he would have to wait another day for the doctor’s clinic to try and get him free sample medications to cover for the month. My friend had run out of that medication the day before, and if Illinois Medicaid had covered his prescription he would not be in this current mess. So he had to do without one of the medications he needed for a day and a half. He was very, very concerned that he might fall ill and have to be rushed to the emergency room of a hospital. Fortunately this did not happen. Two days after he could not get his prescription medications, he was able to obtain the free samples promised him by the doctor’s clinic.
But he is not out of the woods yet. Because Illinois Medicaid needs special authorization from a doctor or doctors for any one individual who is on more than four prescription medications, my friend’s doctor had to prioritize all of the medications he needs and why he needs them. My friend was told by the CVS pharmacist that before this change came into effect, Illinois Medicaid did not limit the number of prescription medications for those covered by Medicaid. Then a limit of eight medications per month for those on Medicaid was set by the State of Illinois, and now four medications per month. Apparently, some politicians have become the new arbiters in who should and who should not get life-saving medications instead of the doctors who know what their patients need. I was told by one political pundit that this is a cost-saving scheme to save the state, which is already broke, some money.
How is this exactly saving money? If patients on Medicaid are denied or forced to pay out-of-pocket expenses for medications they desperately need but could not afford outside of Medicaid, then these same people may be forced to seek further hospitalization or worse this could force them to go without the medications they need—leading to chronic illness, injury or even death. Is rationing Medicaid really a wise idea? My friend is only one of an estimated 500,000 to 750,000 now on Illinois Medicaid. The Affordable Care Act expanded the number of those who qualify for Medicaid now, and the costs for how this will work still has yet to be worked out. However, a growing number of those on Medicaid, including my friend, have discovered the limits of what Medicaid will do for them. In too many ways, they are being told to ration their Medicaid benefits to help save money. But that savings is an illusion if those on Medicaid are forced to either go without their medications, forced into greater hospitalization, or have to do without their medications waiting for something terrible to happen to them.
Meanwhile, the politicians in Springfield do not have to worry about their medical care, do not have to worry about any limits for receiving medications if they need them, do not have to worry about either paying for medications or food and utilities that those on Medicaid may worry about, and do not have to worry about hospitalization. Of course, I can safely say the politicians do not have to worry about putting food on the table, do not have to worry about their utilities being paid for or bills that cannot be paid. And these are the same people who are determining what limits those within Medicaid should and should not get. This is just one more example why today’s politicians and the people could not be further apart—a divide as great as the Grand Canyon.