Medicaid Cuts Have Consequences

“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”

—Charles Dickens, A Christmas Carol

The words of Dickens’ 1843 classic are reverberating throughout Harrisburg, Pennsylvania. The budget for the pharmacy section of Access (Pennsylvania’s version of Medicaid) has been slashed and burned, and Governor Tom Corbett would probably cut more if he could.

The governor’s administration has seen fit to limit the number of prescriptions per month that a patient can get to 6. Now, I have seen drug regimens with 15 to 25 drugs (or even more) in them. The bottom line is that, based on these limits, out-of-pocket costs for a high-maintenance patient could be staggering. Many patients are going to be forced to choose between medication and food, and the consequences for many will be dire.

The administration, however, is not without a heart. The restriction is lifted on those under 21 years of age, pregnant women, and those living in a nursing home or other intermediate care facility. No one wants to be involved in a fetal demise or death-of-a-child lawsuit, after all. Prior authorizations can be approved for medications that are life-threatening (ie, insulin) when not taken. Good job to the lawyers for figuring out that one.

Pharmacy staffs across the Commonwealth are “thrilled” with the decision. Although a letter was sent in December 2011, apparently many people didn’t read it. Now, either a pharmacist or a tech has to inform patients that some of their prescriptions no longer cost between $0 and $3 as they used to, and there is nothing we can do about it. As the bearers of bad news, pharmacy staffers are taking a lot of heat for this. It is highly unappreciated. This was not our idea.

One way to curb Medicaid expenses is to crack down on fraud and unnecessary cases. When a known drug dealer pulls up in an Escalade and whips out his Harrisburg Gold Card, I am offended. When a Lexus-driving doctor with good insurance has a kid with a chronic illness and uses Access to pick up the copays that are highly affordable, given their tax bracket, it irks me. I have witnessed examples of both of these scenarios in my career, and I can’t believe there isn’t more thorough investigation of them.

There’s a silver lining here for pharmacists, however. We can use our Medication Therapy Management skills to streamline drug regimens. We can reduce costs if you allow us (pay us) to put our skills to work. In the long run, it will save you money. Thank you, Governor Corbett, for this disaster. Remember, Pennsylvania residents, the majority of you voted for this. Peace.

Jay Sochoka, BSPharm, RPh, CIP, hopes the ghosts of pharmacy past, present, and future will visit the governor sometime soon.