Archive for December 12th, 2007

Trouble With Georgia Medicaid

Wednesday, December 12th, 2007

Medicines Abilify and Zyprexa

After DS’s first hospitalization I went through a great deal of trouble to try to get his medication for him. First the drug store we usually used did not have Abilify in stock. Also, they said there was going to be trouble with Medicaid paying for it. Apparently they had some kind of computerized or telephone communication with Medicaid. It took me days to understand what they trouble was. I was still putting the pieces together six weeks later after his second hospitalization (story to come).

I had had enough for the day, when the drug store could not fill the prescription. I went home with every intention of putting it on the top of my list of things to do for the next day. DS was bothered by the issue, and despite my explanation he wanted to make an attempt himself to have it filled at another drug store. He got in his car to drive to it.

I was worried about him driving or even being alone, unsupervised, outside of the house. While he was gone he got a flat tire. I had to get the little ones in the car again and pick him up. What a day.

The next day I tried to deal with the issue of getting his medication. The office of the psychiatrist DS was seeing before going into the hospital said they would not help because it was an issue for the discharging physician at the hospital. That only made a little sense to me because this doctor, whom I will call Dr. DB, had actually recommended Abilify the last time we had seen him, pre-hospital.

Next I called the office of Dr. V, the discharging hospital physician. Even when given some time, the staff person had difficulty discussing anything that the doctor did in the hospital because communication with the hospital was not good and apparently not much better with her employer, the doctor. The staff person said they would call Medicaid and try to find out what was happening. Nothing was resolved that day. I went to the drug store in the evening (a new one that had Abilify in stock) to pick up DS’s dosage for that one day. I was going to pick up his medicine one day at a time because I had also learned that day that it was $20+ per day or per pill to take. We could not afford to pay a whole months worth. I was hoping things could get cleared up in a day or two.

After doing that for a couple days, Dr. V’s office offered us free office samples. I had to drive to Austell, about 45 minutes away, to get them. They gave us a two week supply. Then this particular staff person apparently went on a long vacation, and this doctor’s office became particularly uncommunicative. I do not know if it was apathy, incompetence or a ruthless concern for their bottom line. I seriously considered filing some kind of complaint against this doctor with somebody, but I was too overwhelmed day-to-day with DS and his problems to take any kind of action to find out how to do that.

I tried to deal with Medicaid directly, telephoning them. I learned the objection that Medicaid was raising to the Abilify is they felt a cheaper drug such as Geodon should be tried first. I told them it had been tried in the hospital. I did not know what to do to make something happen. I tried calling the hospital and asking them to talk with Medicaid on my behalf. Finally about six weeks later in dealing with a different medication problem with Medicaid, I learned that as far as Medicaid is concerned, a doctor’s office must file the appeals and paperwork to make them reconsider a case. I could talk until I was blue in the face, and they would not take action.

In the meanwhile, DS’s symptoms were gradually worsening. I was in communication with his first psychiatrist, Dr. DB. Through his office we got more office samples. I still have about $300 worth of office samples in my house that I guess are going to get thrown out when they expire.

There were a great number of things going on at this time, but as far as the issue with Medicaid and Abilify was concerned, it was never resolved. I tried writing a letter to them sending it to two different addresses because I was not sure which one was the right one. I never got a response. I found out about an organization called Rx for Less that would help to pay, but I needed a letter from Medicaid saying they were not going to pay. As it turns out, DS continued to worsen while taking the Abilify and entered the hospital again. There his medication was changed again.

I dread ever having to call Georgia Medicaid about anything.