My work day after Thanksgiving in this new city proved to be vastly different than what I am accustomed to. Whereas I am used to being completely swamped on Black Friday, here the pharmacies are a wasteland. So imagine my surprise when midway through the day I realized I was in the presence of greatness.
I had met the Medicaid Mother of the Year. Shocking, I concede, that she would choose to visit our little pharmacy on this day, but alas here she stood.
Chatting on her iPhone 4, bedazzled of course, with her Coach purse and fancy manicured nails, she presented to prescriptions for her 18 month old son. And she presented her, and her son's, Medicaid card.
One of the prescriptions was written for Amoxil and the other for Orapred, nothing out of the ordinary. As she loudly chatted with one of her baby's daddies, I took the scripts to the counter and began to input them. It was then that I noticed both scripts had the DAW box checked.
Perplexed, I dialed up the urgent care doc who had written the scripts and asked the nurse on call if she could verify the DAW. Often a slip of the finger can slap DAWs on scripts when they are unintended. When the nurse returned to the phone she informed me that it was the patient that had insisted on the DAW and that they were written correctly.
Cute.
We call her to the counter and the pharmacist asks her why she's insisting on the name brand version of these medications. Her reply was that, "Generics don't work that good and she wants the best for her bab-ah."
We both calmly explain that in order to fill each of these prescriptions we would have to order the drug in. The likelihood that a store in our area would have either one of these drugs in stock was negligible. And, since it was a Friday, we informed her the soonest we could get the medication would be Monday morning.
"That's ok," she replies.
Next we inform her that in order for Medicaid to pay for these medications we're going to have to get a prior auth on both drugs. That, in itself, meant that we wouldn't be able to bill the insurance for payment until Wednesday at the absolute earliest.
"I'll just wait, he can tough it out until then, he's a strong lil dude like his daddy. I just want him to get the best meds, I don't want none of that cheap shit."
Let's get her tiara and flowers ready, because this woman just kicked the rest of the competition to the freakin' curb.
Yes, let's deprive your ill child of the medication he needs simply because you have some sort of righteous belief that you deserve the best even though it is those like myself who will pay for it. Never mind your suffering child, hold tight to that notion.
Because when child services show up, it's the only thing you're going to have left.
12 comments:
18 YEAR old? Tell me that's a typo, and you meant 18-month-old, because it was brand name liquids for her adult son, I'd really brand her a b****!
Yikes, I missed that typo on three proofreads...
Oh wow! Cute indeed!!
I would like to nominate a customer I had a couple years ago for "Miss Medicaid Mama 2010"
A glimpse of my situation is as follows:
Me: Alright your son's antibiotic comes to $3 total
MedicaidMama: Whoa whoa whoa whoa whoa WHOA. Three dollaz?! It ain't be free?!
Me: Unfortunately not
MedicaidMama: Well he just gonna have to be without then. Here ring this up for me *places $35 worth of makeup on counter*
Me: ...
So is the kid going to end up in the ER over the weekend and cost us all some bonus bucks? Amazing.
How it used to burn me when I had Medicaid patients come in who were dressed well enough to attend a state dinner at the White House and had jewelry-bedecked fingers! There was always something terribly wrong with that picture. I never worked a drive-thru, but I suppose the picture is even less palatable when you see them dressed like that and are also driving a BMW. Of course, I can't pick apart the real reasons for all that, but pricey accoutrements and poverty are NOT supposed to mix. Sorry. I can't accept that image. Call me insensitive. I call it just plain Scandinavian, as in "Something is rotten in the state of Denmark."
Yeah it's frustrating but healthcare and poverty are two separate things. I know incredibly wealthy people that can't get health care. I know this is what we see, and easy to lump in with all the "welfare moms" but there are also millionaires who claim their social security. She obviously qualified for Medicaid despite what she chooses to spend her money on. Rich and middle class people who can't or choose not to get healthcare cost just as much in the ER. Is this woman not supposed to have any nice things? I mean yah it's frustrating she's poorly raising a child but what are the options here, are we angry we're not in the dole as well or that she has some nice things in what's probably not an otherwise great life.
@Frautech,
I think the problem we have with this situation is that she can "afford" these luxuries that we pay for and do with out because we are responsible.
My MAJOR issue with Medicaid is people with real disease states (cancer) cannot qualify for benefits that they have worked for because THEY WORK.
Come work a day in mine or Phat's pharmacies and you'll change your mind real quick.
I'm not a pharmacist, so I don't know - Couldn't the doctor have refused to write DAW? Do you have to dispense it if the patient demands it or can you tell them to go elsewhere?
To Frau Tech - I'm not incredibly wealthy, but I was willing to pay big bucks for a good insurance policy, but was denied because I have Ehlers Danlos. I had to apply for disability (which I don't really need) just so I could get medicare coverage. Talk about wasted government spending. (I did teach school for 20 yrs. before I got too ill to work.)
I would have given baby momma 3 choices:
1) Change to generic (only because MD didn't care and checked DAW to please mom) and have it covered under card,
2) Order the brand for Monday and politley inform momma that her desire to have "none of that generic shit" is NOT an acceptable reason for medical necessity, she will have to pay FULL PRICE, or
3) Send her to your arch enemy pharmacy saying good luck.
To cover my ass, I would at least keep a copy of the rx (or stickers created when running it as cash) and document what I did, so if there was a lawsuit, if option #3 were to be chosen.
After 20 years as a pharmacist, I am in the process of leaving BECAUSE of bullshit like this.
No wonder the country is going broke.
"All that is necessary for evil to triumph is for good men do nothing."
-Burke
A welfare state creates welfare whores...duh. If Medicaid pays for those brand name scripts, remember who is really paying for it. Keep working, those welfare whores depend on you.
Yeah!
Good luck on getting a prior auth from an urgent care doc.....BWAAAAHAHAHAHA. Wednesday? TRY NEVER!!!!
I mean, what can he/she justify it by? Patient having tried and failed generic already for the ear infection that most likely will be gone by Wednesday???
Tell the patient that it'll be $68 total, cash or credit b/c Medicaid ain't paying and I will thank you for not wasting my tax dollars on this nonsense.
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