Help Needed : Medicaid and Prescription Drugs.

[liberalnarb]

I have an aunt who has been relying on Medicaid for health coverage since last year. Several months ago she had to undergo back surgery due to experiencing a slipped disk. Medicaid covered the procedure, no issues there. However, the surgery was unsuccessful in taking care of the problem and she will not be able to have another operation until August. In the meantime she has been taking prescription painkillers. Her doctor wrote her a prescription for oxycodone. Recently, at the pharmacy she was informed that the month long authorization of coverage for the medication ended at the end of June. When she attempted to pay for the medicine out of pocket we were told that in Pennsylvania, where we live, recipients of Medicaid are not allowed to pay for denied medications out of pocket and by allowing her to buy the medication out of pocket, the pharmacist would risk losing his job. Our hands are tied and I'm afraid that she will experience extreme pain and/or withdraw. Does anyone know anything that could help with this? What's the background on this bizarre law?

[RandomAccess]

1. What do any of her doctors say?

Can she (or you) talk to a social worker at the hospital where the surgery was performed?

AARP?

United Way for a referral?

I'm not quite sure what your question is. I understand you need help, but what exactly? In any case, that's the bottom of my suggestion bag.

Good luck!

[liberalnarb]

8. I guess I'm not really sure exactly what question I need to ask right now.

I'm desperate in looking for a way to help get her the medicine she needs and I just thought I'd post about it here to see if any DUers knew something about this that might help, many DUers seem to be well-versed in these things. On a side note I was asking what the origin of this law is, because it seemed like the sort of thing the republicans would implement to make life as miserable as possible for Medicaid patients.

[trixie2]

2. It may be that the new laws are impeding her medical needs

The Opioid crisis has also impacted those who truly need medicine. My sister had spinal surgery and had to wait a week afterwards because her doctor prescribed the drugs prior to the surgery after an accident.

This may help.

[jxla]

7. Pennsylvania's regs may not be the same as NJ's

[link:http://www.health.pa.gov/my%20health/diseases%20and%20conditions/m-p/opioids/pages/prescribing-guidelines.aspx#.W0iGHNJKiMA|]

"The Department of Health and the Department of Drug and Alcohol Programs convenes the Safe and Effective Prescribing Practices Task Force. ... The task force developed and adopted guidelines for ten medical specialties on the safe and effective use of opioids in the treatment of pain."


Also, Medicaid is different in every state. The Medicaid/Medical assistance page on
Pennsylvania's DHS website has links that may help.
[link:http://www.dhs.pa.gov/citizens/healthcaremedicalassistance/index.htm|]

[pnwmom]

3. So Medicaid won't authorize it even if the doctor issues a new prescription? That's terrible. n/t

[liberalnarb]

12. It is terrible.

This law has republican written all over it. Seems like something they would do to put Medicaid recipients through hell. As I said this problem is specific to our state and we've been the victims of some pretty ruthless right wing governance. Tom Wolf is the only thing keeping us from falling over the edge.

[Crunchy Frog]

4. This is how they're fighting the drug war.

They're making it as difficult as possible, and Medicaid patients are particularly easy targets for these restrictions. These policies are leaving vast numbers of people in unspeakable agony.

I would talk to as many people as possible to try to get the prescription sorted out. If you can't, you might look into an herb called kratom. It may help with the pain, and it would definitely help with the withdrawl.

Sorry she's going through this.

[appalachiablue]

6. Oh yeah, THESE are the people, the 'bad hombres' to punish! Xt!

What a hassle, I hope your aunt gets a quick resolution and smthg. soon to ease the pain. Even Vicodin if available.

[liberalnarb]

9. Thanks. nt

[Nay]

5. First, talk to her doctors - go along with her to her appts and have her designate you as

one of the people who can access her info.

Second, if the docs can't seem to do anything, ask if the hospital has a patient ombudsman/patient advocate. The advocate can help you navigate through the mess.

[liberalnarb]

10. Yeah, her doctor was able to help sort out something like this before. She's supposed to get in

touch with him soon, although he isn't the most accessible. His office tells us he's "swamped" and will get to her when he gets the chance. For-profit healthcare is just the best, isn't it?

[trixie2]

15. I don't think it matters if you pay for it or not

My dentist is a dental surgeon and has to space his patients out because HE CAN'T WRITE SCRIPTS ABOVE A CERTAIN NUMBER DURING A CERTAIN PERIOD OF TIME. He has gone back to regular dentistry to round out his practice. They are watching doctors, pharmacies and patients at large. I know someone who is on dialysis 3 days a week and was sent a letter that she is being investigated for unlawful drug use/selling.

It is out of control.

[yallerdawg]

11. The prescribing doctor's office has to get an override or a new authorization.

Just let them know.

The states are really trying to end unnecessary use of opioids and hold doctors accountable when prescribing.

If determined to be medically necessary, no doctor will have a problem - they are just unaware of when the state agencies cut people off.

[liberalnarb]

13. Thnx. nt

[NightWatcher]

14. Get her some medicinal cannabis

Or street weed if that's all you can get.

Might I recommend the strain Purple Trainwreck.

It's helped alleviate pain and avoid opioid withdrawals for many.

Please look into this.

[trixie2]

16. That is good advice

[RandomAccess]

17. GREAT idea

[greatlaurel]

18. Slipped discs are incredibly painful. Patients need effective pain management.

In some areas I have heard hospitals are refusing opioids for sickle cell anemia patients, too. Sickle cell is incredibly painful. Denying painkillers to those in need is beyond cruel. This is a silent crisis aimed at those who have no voice, in my opinion. Those in greatest pain cannot donate money or call their representatives.

My suggestion is similar to others, but I am adding a couple extra bits of info from my personal experiences with a slipped disc. She needs an advocate who is legally designated to fight for her needs. She should go to her family physician to see if there are any other alternative pain medications or a recommendation to a pain specialist. That is probably who she is already seeing, but if she is not, I highly recommend it.

When I had a slipped disc, it was nauseatingly painful. so your aunt has all my sympathy. I found that the opioid pain medicines were not as helpful as I expected. Surprisingly. I got the most relief from over the counter ibuprofen. Ibuprofen can be a problem for people who have other medical reasons to not take ibuprofen. Her family doctor should be able to help her navigate these complexities to get her some interim relief. Ibuprofen helps with inflammation as well as the pain. She needs to consult with her medical team to see what alternatives are safe for her.

The best thing that happened to me was I was sent to a pain management specialist. He helped where no one other physician or chiropractor was able to help. The pain management specialist in combination with physical therapy was able to get me pain free and regain the use of my arm. I had lost 87% of the nerve function in my arm due to the slipped disc.

I urge you or another advocate to go with her to her family doctor to put together an effective short term and long term pain management plan as soon as possible.

Good luck to you and your aunt.