Summary adverse impacts Medicaid Prescription Copay and Restrictions
Few have an understanding of what is going on in this country regarding health care for the poor. Those who are poor and mentally ill are most impacted. Most people hear what state officials and insurance companies want them to hear. The aged, blind, disabled, and institutionalized comprise many on Medicaid. The poor have little power, transportation, or skills in communication. Those caring for them are busier than ever in these times. The poor and those who provide for them is easily drowned out by those hoping to put off responsibility and dollars and costs. Medicaid and the politics of groups Health Affairs on Medicaid
Clearly state budgets are facing challenges, especially education and health care with proscriptions a major reason (October 2002 Status of States and Medicaid Prescriptions http://www.kff.org/content/2002/160902/1609-02.pdf ) Reasons for increases in prescription costs Crisis Health
Appeal to State Leaders Regarding Poor
More recently states have chosen to save costs by adding copays and restrictions to Medicaid prescriptions. Studies support savings in prescription costs, but these are simple calculations determined by accountants, not including increased costs in other areas No study has documented overall savings in health care costs.
There are clearly major reasons that Medicaid Prescription Copay and Restrictions cause increased health costs and other adverse impacts. Studies from managed care and state programs have actually shown increased costs, particularly in the most complicated Medicaid patients. (National Mental Health Assoc, MediCal) These include increased costs of prescriptions, more office visits, and increased hospitalizations. There is great potential for harm in several groups of Medicaid patients. These poorest of the poor have more out of pocket costs as well. Studies of Medicaid_Prescriptions
Studies show that restrictions and copays may keep Medicaid patients from getting their prescriptions, in some patients this means that patients may not fill prescriptions at all. Basically these policies interfere with the practice of good medical care. Who bears the burden of Medicaid drug copayment policies
Studies also show how certain parts of cities and the poorer parts of the country are impacted Medicaid Nebraska . Medicaid changes can also hurt those caring for poor patients and also medical training programs, impacting the future supply of health care providers for poor parts of the country. Medicaid AAMC
Cuts in Medicaid hurt state economies. This is due to the way Medicaid and other federal programs are funded, and it is also because over half and as much as two-thirds of such programs provide jobs to administrate the program. These are desirable jobs and are also a way for poor people to get out of poverty. For details about the cuts and how they will hurt your state, see www.familiesusa.org
Even before cuts in Medicaid and copays and restrictions to medications, the health care system has major problems. These often act to force people back into poverty despite their best efforts. Physician Observations Regarding Mental Health and Health Insurance in Nebraska
What is interesting is how states are arguing currently before the Supreme Court that prescription access is important to the care of poor people, elderly, etc., but nearly all have acted to limit access with copays, formularies, limits on number of prescription, prior approvals, and other restrictions. Pure hypocrisy!
Rebates on Medicaid PrescriptionsWhat Medicaid can and cannot do and what are some of the problems with prescription restrictions http://www.healthlaw.org/pubs/19990808MedicaidDrugs.html
Includes provider management studies in several states and recommendations:
http://aspe.hhs.gov/health/reports/PCCM/pdf/index.pdf This was
document produced for HHS that I was a participant in. Roger A.
Hofford, M.D. Roanoke, VA
Underserved - Overview and Models
An updated survey shows that the deepening fiscal crisis at the state level is threatening Medicaid coverage for low-income families. "Medicaid Spending Growth: A 50 State Update for FY 2003," released Jan. 13 by the Kaiser Commission on Medicaid and the Uninsured, found that nearly two-thirds of states have implemented or are planning a second round of Medicaid cuts. For more information, go to ( http://www.kff.org/content/2003/20030113/ ) and click on "News Release."
Another survey, released Jan. 16 by the advocacy group Families USA, shows that Medicaid cuts would cause states to experience large reductions in jobs, wages and business activity. For example, the report found that, on average, each million-dollar reduction in Medicaid spending would cause a loss of $3.4 million in business activity. "This harm is in addition to the many difficulties faced by low-income families when their Medicaid lifeline is cut," said Ron Pollack, executive director of Families USA. http://www.familiesusa.org/statemedicaidcuts.htm ) for more about this survey.
Medicaid and Pediatricians 2002
Funding of Graduate Medical Education by State Medicaid Programs – booklet to order http://www.ncsl.org/statefed/pubslst1.htm#fundinggme
Main Web site www.ruralmedicaleducation.org
Physicians products of society but
Lederer in Time to Heal states that physicians are a product of the society that we live in. We live in a society of instant gratification. Few if any want to accept responsibility for their actions. Good patient care demands constant vigilance on the part of patient and physician. Often, in the process of good care, doctors and patients will be at odds with one another. I like what Lee Golusinski, MD had to say:
"When patients get upset and say I am being parental and coercive by doing this, I remind them that there are three names on each bottle of medication: the patient's, mine, and the pharmacist. We all have responsibilities on this team, and if one of us is not meeting those responsibilities (such as monitoring INRs for patients on coumadin), I will not take on the risk they bring by not meeting their responsibilities."
Addendum by RCB in 2003 - Of course I did not know back then that the state would enter the fray by making restrictions and co-pays such that patients would not fill the prescriptions anyway.