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16

Rationing Begins: States Limiting Drug Prescriptions for Medicaid Patients

13 comments, 169 views, posted 3:13 pm 31/07/2012 in News by Viscera
Viscera has 11737 posts, 1446 threads, 743 points, location: 1123 6536 5321
Lord of Glencoe

(CNSNews.com) – Sixteen states have set a limit on the number of prescription drugs they will cover for Medicaid patients, according to Kaiser Health News.

Seven of those states, according to Kaiser Health News, have enacted or tightened those limits in just the last two years.

Medicaid is a federal program that is carried out in partnership with state governments. It forms an important element of President Barack Obama's health-care plan because under the Patient Protection and Affordable Care Act--AKA Obamcare--a larger number of people will be covered by Medicaid, as the income cap is raised for the program.

With both the expanded Medicaid program and the federal subsidy for health-care premiums that will be available to people earning up to 400 percent of the poverty level, a larger percentage of the population will be wholly or partially dependent on the government for their health care under Obamacare than are now.
In Alabama, Medicaid patients are now limited to one brand-name drug, and HIV and psychiatric drugs are excluded.

Illinois has limited Medicaid patients to just four prescription drugs as a cost-cutting move, and patients who need more than four must get permission from the state.

Speaking on C-SPAN’s Washington Journal on Monday, Phil Galewitz, staff writer for Kaiser Health News, said the move “only hurts a limited number of patients.”

“Drugs make up a fair amount of costs for Medicaid. A lot of states have said a lot of drugs are available in generics where they cost less, so they see this sort of another move to push patients to take generics instead of brand,” Galewitz said.

“It only hurts a limited number of patients, ‘cause obviously it hurts patients who are taking multiple brand name drugs in the case of Alabama, Illinois. Some of the states are putting the limits on all drugs. It’s another place to cut. It doesn’t hurt everybody, but it could hurt some,” he added.

Galewitz said the move also puts doctors and patients in a “difficult position.”

“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way,’” he said.

Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia have all placed caps on the number of prescription drugs Medicaid patients can get.

“Some people say it’s a matter of you know states are throwing things up against the wall to see what might work, so states have tried, they’ve also tried formularies where they’ll pick certain brand name drugs over other drugs. So states try a whole lot of different things. They’re trying different ways of paying providers to try to maybe slow the costs down,” Galewitz said.

“So it seems like Medicaid’s sort of been one big experiment over the last number of years for states to try to control costs, and it’s an ongoing battle, and I think drugs is just now one of the … latest issues. And it’s a relatively recent thing, only in the last 10 years have we really seen states put these limits on monthly drugs,” he added.

Extra Points Given by:

griffin (5), Quaektem (10)

Comments

0
3:19 pm 31/07/2012

Viscera

Quote by Viscera:
“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way,’” he said.


We ran into this. My wife has asthma, and she has all kinds of trouble getting the right dosage of a drug that helps alleviate her symptoms, but it usually takes three or four tries in regards to the brand, as some have side effects and others don't.

4
3:25 pm 31/07/2012

griffin

But don't worry, this is just an attempt at cost-optimisation. We're not talking death panels or anything like that. So relax. Chill.


Hey look! Puppies!

1
4:14 pm 31/07/2012

Quaektem

Oh come on, this is just a way to stick it to big Pharmaceutical... kill the demand for drugs by killing the people that rely on them the most and it will drive down drug costs.

Who can argue against basic economics, amIright?

1
11:58 pm 31/07/2012

Cnik

This is only for brand name drugs, not generics. There is no limit on generics.

2
12:11 am 01/08/2012

Quaektem

Quote by Cnik:
There is no limit on generics.



Yet...

Also, some medications are not available in generics, I take Cymbalta for fybromyalgia and that is not available as a generic (and have to go to a specific pharmacy to get it covered under my health plan).

2
1:41 am 01/08/2012

Flee

I say fuck the pharma companies that hold patents on drugs so no generic is available. fuck them all. In the business of saving lives, my ass!

2
2:19 pm 01/08/2012

Viscera

they aren't in the "business" of saving lives, they are in the business of drug research. That costs alot of money. Dr's aren't in the "business" of saving lives either, they are in the business of treating symptoms. ER Dr's and military medics are life savers. This system is all messed up I'm wit ya Flee

0
2:20 pm 01/08/2012

Viscera

I know this will make my capitalist friends mad, but shouldn't there be parts of society that aren't for profit? Like basic shelter, food and medical services? Why can't there be basic stuff for sustenance that isn't for profit?

0
2:34 pm 01/08/2012

griffin

Quote by Viscera:
Why can't there be basic stuff for sustenance that isn't for profit?


For the same reason that everything can't be free. It doesn't work. And who would engage in a series of transactions in which they merely broke even?

0
2:37 pm 01/08/2012

Viscera

non-profits. Habitat for Humanity builds houses that cost the "owners" almost nothing except sweat equity. We donate conputer services to those who can't afford it where I work, going and fixing their computers at no cost when applicable. Here is a web site that helps people financially and doesn't ask for repayment.
Kiva financial aid

1
3:50 pm 01/08/2012

griffin

You're talking charity now, but your question is about economics. The reason why there isn't free stuff everywhere is because it isn't worthwhile for people to do it. Your company can only engage in charitable behaviour because it is primarily a for-profit enterprise. Who would invent better ways of farming unless there was a profit motive? Why should someone be efficient if they get paid either way? Why do you think food production in North Korea sucks so much ass?

0
4:56 pm 01/08/2012

Quaektem

Quote by Viscera:
I know this will make my capitalist friends mad, but shouldn't there be parts of society that aren't for profit? Like basic shelter, food and medical services? Why can't there be basic stuff for sustenance that isn't for profit?



No, I'm not mad at all. In fact the first hospitals were charities! Insurance, litigation, and regulation has all but eliminated any motive to keeping healthcare affordable to the average, uninsured person. We get upset at pharmaceuticals but allow our doctors to scoff at natural remedies that just as effectively treat problems at pennies on the dollar.

You want healthcare fixed? Make people start paying for it and see how demand for cures over treatments, inexpensive over patented, and 'alternative' medicines will pay out... the exact opposite of what the current insurance environment is working towards.

As for alternative medicine... my grandfather's doctor wanted him to go on a drug for his heart and one for high cholesterol. He became lethargic and disoriented on the meds and so discontinued them. His doctor was pushing more meds to counteract the effects of the first two and he flat out refused. When I heard about it I suggested that, since he wasn't going to take the meds anyway, he might try taking cinnamon (for the heart) and red yeast (for the cholesterol). The doctor thought he went back on the meds when he went in six months later. Not saying this is typical, just something that worked for his particular biology (and there are other treatments that might work if those don't) but now he spends about $10/month on stuff that leaves him feeling good rather than a copay of $50 (think about how much the real cost is!) for pills that make him feel like shit.

1
5:22 pm 01/08/2012

elsels

Ok V, while I agree with you that some things should be for free there is a cost to all of those things. It costs thousands upon thousands of dollars into the hundreds of thousands to become a doctor, to become a specialist, a surgeon. Who will shoulder the cost of such education and specializing. Who pays for the outrageous amounts of money that it takes to do research on prescriptions, medical gadgets, latest technology. None of it, none of it is free. It takes incredible skills, intelligence, specialized training, facilities and machinery to come up with all those things, they cost money. That is why it is not free. Doctors, manufacturers, engineers all have to eat, put shelter over their families heads... You don't get good care if those who are supposed to do the caring are not well taken care of.

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