Current Events > Medicaid is horrible. Trying to deny a patient's end of life medications.

(+) Yeah! (+)

We got a patient on Friday with end stage pancreatic cancer. The doctors didn't think she'd make it through the weekend. To start, she was in the hospital, but I was told that Medicaid demanded she be moved to the Long Term Care/Swing Bed unit instead.

We got orders at our pharmacy for anti-nausea medications, which was fine, and then several pain medications including fentanyl and oxycodone. Medicaid denied all. We tried several variations, strengths, etc. in the hopes that we could find something Medicaid WOULD accept. At some point we learn Medicaid is denying one of them because she's also on an antianxiety medication, which is completely ridiculous. My coworker called Medicaid and learned that they wanted a very specific brand of oxycodone that's $1000 a bottle, which we couldn't do and it'd take a day to arrive anyway.

Finally after plenty of hassle, we got a morphine tablet through them and we got it sent up. The moral of the story? Medicaid doesn't care if you're on your deathbed or not. They'll try to save money to your last breath. God awful insurance.
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Evil people in this country.
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Indeed.
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And republicans spend all day making fun of "entitlements."
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That's really shitty
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stop making shit up no1 cares
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Elections have consequences.

One bump just in case anyone wants to see how garbage Medicaid is.
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Medicaid is legit terrible
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Or just lower da price of healthcare drugs, $1k for a bottle wtf are you guys trying to pull
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ssj3vegeta_ posted...

Or just lower da price of healthcare drugs, $1k for a bottle wtf are you guys trying to pull

Youll have to take that up with manufacturers

Ill tell you right now thats nothing compared to some other meds
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DezDroppedFreak posted...

Medicaid is legit terrible

My experience is solely with one state's Medicaid program, but I can't imagine other states are much better.
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LanHikari10 posted...

DezDroppedFreak posted...

Medicaid is legit terrible

My experience is solely with one state's Medicaid program, but I can't imagine other states are much better.

Most people here probably don't even realize Medicaid is a state/federal hybrid.
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LanHikari10 posted...

DezDroppedFreak posted...

Medicaid is legit terrible

My experience is solely with one state's Medicaid program, but I can't imagine other states are much better.

Can confirm Alabama is not any better
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By the way, if you're trying to get end of life meds, you're better off using Medicare's hospice provision. That's what it's designed for.
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Well. I'd much rather be on Morphine than Oxy. Can't exactly say it's a bad call to prevent that shit from getting prescribed at the rate it does.
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DezDroppedFreak posted...

ssj3vegeta_ posted...

Or just lower da price of healthcare drugs, $1k for a bottle wtf are you guys trying to pull

Youll have to take that up with manufacturers

Ill tell you right now thats nothing compared to some other meds

My boss's mother requires an anti psychotic shot once every month that costs like $5,000
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At some point we learn Medicaid is denying one of them because she's also on an antianxiety medication

Opiods and benzodiazepines (taken together) are almost never covered by any insurance, including Medicaid and Medicare, because of the rush of death by respiratory failure.

You did a pretty good job of convincing me that this was "wrong" until I realized this detail.
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Coffeebeanz posted...

By the way, if you're trying to get end of life meds, you're better off using Medicare's hospice provision. That's what it's designed for.

That depends if the patient is eligible for Medicare.

P sure lan knows what hes doing
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Its nothing but greed why meds are so expensive.

How can something that's conjured up in a lab cost so much?

It's not like fruits and vegetable where its dependant on the season.

Makes me sick.
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glitteringfairy posted...

DezDroppedFreak posted...

ssj3vegeta_ posted...

Or just lower da price of healthcare drugs, $1k for a bottle wtf are you guys trying to pull

Youll have to take that up with manufacturers

Ill tell you right now thats nothing compared to some other meds

My boss's mother requires an anti psychotic shot once every month that costs like $5,000

it's always for profit FML. one better hope they don't get sick.
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Coffeebeanz posted...

At some point we learn Medicaid is denying one of them because she's also on an antianxiety medication

Opiods and benzodiazepines (taken together) are almost never covered by any insurance, including Medicaid and Medicare, because of the rush of death by respiratory failure.

She's not taking it anymore. It's just on her recent history. All regular meds are discontinued in favor of just pain/nausea control.
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LanHikari10 posted...

Coffeebeanz posted...

At some point we learn Medicaid is denying one of them because she's also on an antianxiety medication

Opiods and benzodiazepines (taken together) are almost never covered by any insurance, including Medicaid and Medicare, because of the rush of death by respiratory failure.

She's not taking it anymore. It's just on her recent history. All regular meds are discontinued in favor of just pain/nausea control.

Then she really needs to go on hospice. Why is she going to LTAC or a swing bed if the patient is terminal?

Unless she's refusing hospice, in which case this is almost always what happens.
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That's the only part I don't understand. I was told she was forced into LTC/Swing bed because that's what Medicaid wanted.

gamestunner posted...

Its nothing but greed why meds are so expensive.

How can something that's conjured up in a lab cost so much?

It's not like fruits and vegetable where its dependant on the season.

Makes me sick.

I understand why, to an extent, since it takes a drug billions of dollars and 10-15 years of research to go from idea to FDA approval.
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It's cruel to force someone into an LTAC if they're moving to comfort measures only. Hospice is an automatic qualification as long as she has less than six months and would cover all end of life meds and home care for free.
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Its nothing but greed why meds are so expensive.

How can something that's conjured up in a lab cost so much?

A lot of name brand drugs are overpriced, but some (monoclonal antibody drugs) are legitimately expensive to make.
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LanHikari10 posted...

That's the only part I don't understand. I was told she was forced into LTC/Swing bed because that's what Medicaid wanted.

gamestunner posted...

Its nothing but greed why meds are so expensive.

How can something that's conjured up in a lab cost so much?

It's not like fruits and vegetable where its dependant on the season.

Makes me sick.

I understand why, to an extent, since it takes a drug billions of dollars and 10-15 years of research to go from idea to FDA approval.

I can see that, but some meds at 1k a pill? That's ludicrous, I dont care if they spend a trillion on development.

It's like the modern plague. You cant afford meds or get denied, you die, or suffer until you die.
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Well Friday afternoon we were told she wasn't supposed to survive through the weekend, but she's still kicking.
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I can see that, but some meds at 1k a pill? That's ludicrous, I dont care if they spend a trillion on development.

There are some meds that legitimately cost that much to make.
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The cost across the board is too high. You can pick on chemo if you want, but meds especially for ongoing illness are purposefully inflated. There was a Dirty Money episode on it.
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DezDroppedFreak posted...

ssj3vegeta_ posted...

Or just lower da price of healthcare drugs, $1k for a bottle wtf are you guys trying to pull

Youll have to take that up with manufacturers

Ill tell you right now thats nothing compared to some other meds

An important distinction here is that the sticker price isn't real or behaves like prices in regular consumer markets.

Manufacturers have contracts with certain distributors, etc, which downstream leads to essentially what is called a "formulary" on any given insurance plan.

This means that a "$1,000" bottle of a medication for insurance plan A actually costs "$100" to insurance plan B. If the plan not under the formulary wants that medicine though, bypassing this system means the cost would be $1,000. In other words, they'll never buy the "$1,000" medicine. They might instead go with a "$5000" bottle that costs them $200.

The 1000 bottle is more expensive to insurance plan A than the 5000 bottle, because to them the actual cost of 5000 bottle is only 200.

With insurance plan B, the 1000 bottle is cheaper because it's only 100 to them, but the 5000 is obviously too expensive for them.

Couple this with thousands and thousands of medications, lab tests, medical devices, etc and you have an impossible web whereby no one can actually come to the true cost or optimal outcome for anyone involved. But calling it a $1000 bottle of medicine is misleading, because it likely has several different prices depending on the context.
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Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.
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Nuffinz0rz posted...

And also sadly accurate
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Coffeebeanz posted...

I can see that, but some meds at 1k a pill? That's ludicrous, I dont care if they spend a trillion on development.

There are some meds that legitimately cost that much to make.

You said that, and I can agree to an extent, but that's a very miniscule amount.

I'm talking about stuff like opioids given to heroin addicts like candy, yet diabetic meds can break the bank.
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Abyssea posted...

Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.

This is an incredibly stupid post lmfao

Like no way you work in billing if this is how you responded to those rx for end of life care
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gamestunner posted...

Coffeebeanz posted...

I can see that, but some meds at 1k a pill? That's ludicrous, I dont care if they spend a trillion on development.

There are some meds that legitimately cost that much to make.

You said that, and I can agree to an extent, but that's a very miniscule amount.

I'm talking about stuff like opioids given to heroin addicts like candy, yet diabetic meds can break the bank.

Metformin and NPH insulin are super cheap. The issue with diabetes is usually compliance with meds.
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Damnit Ophelia :(
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DezDroppedFreak posted...

Abyssea posted...

Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.

This is an incredibly stupid post lmfao

some people arent ready for a reality check i guess
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@DezDroppedFreak don't feed him lol
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Abyssea posted...

DezDroppedFreak posted...

Abyssea posted...

Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.

This is an incredibly stupid post lmfao

some people arent ready for a reality check i guess

Yeah no way you work in billing

Nice try Ophelia
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Yeah, thats what happens when you wildly underfund a program like that.
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LanHikari10 posted...

@DezDroppedFreak don't feed him lol

I couldnt help it man

That post killed brain cells
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DezDroppedFreak posted...

Abyssea posted...

DezDroppedFreak posted...

Abyssea posted...

Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.

This is an incredibly stupid post lmfao

some people arent ready for a reality check i guess

Yeah no way you work in billing

Nice try Ophelia

If you say so, sometimes I wish I didn't tbh. :v Gotta pay the bills somehow though.
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Abyssea posted...

DezDroppedFreak posted...

Abyssea posted...

Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.

This is an incredibly stupid post lmfao

some people arent ready for a reality check i guess

Whole lot of soapbox preachers can't handle the bottom line when it comes to health care, sadly. It's easy to say everyone deserves everything when you have no knowledge of how healthcare operates.
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Coffeebeanz posted...

gamestunner posted...

Coffeebeanz posted...

I can see that, but some meds at 1k a pill? That's ludicrous, I dont care if they spend a trillion on development.

There are some meds that legitimately cost that much to make.

You said that, and I can agree to an extent, but that's a very miniscule amount.

I'm talking about stuff like opioids given to heroin addicts like candy, yet diabetic meds can break the bank.

Metformin and NPH insulin are super cheap. The issue with diabetes is usually compliance with meds.

Inflated diabetic meds are I think the go to in the show I was talking about, something about epi pens being 1000 times the price they originally were.
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Who knew the Republicans were talking about themselves when they were warning about death panels
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Coffeebeanz posted...

Abyssea posted...

DezDroppedFreak posted...

Abyssea posted...

Medicaid still pays for a ton of things. Just because they don't want to hand out narcotics like they're tic tacs doesn't mean they're horrible. Most commercial insurances require the most cost effective prescriptions as well. Yea, it sucks that someone is dying, but you can't let emotion dictate prescriptions of all things. It is just another Tuesday to everyone else and the rules are the same for everyone.

My job is medical billing and if we let emotion dictate how things got done at our offices every center would have a punch bowl full of xanax in every lobby. :v You need to get a grip Lan. Wake up and smell the coffee.

This is an incredibly stupid post lmfao

some people arent ready for a reality check i guess

Whole lot of soapbox preachers can't handle the bottom line when it comes to health care, sadly. It's easy to say everyone deserves everything when you have no knowledge of how healthcare operates.

Im just saying based on my 7 years of pharmacy experience that seems like pretty standard end of life/hospice prescriptions tbh. Either that or a morphine concentrate solution

You cant say you work in billing but then act like thats not standard to provide pain relief at that stage
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P4wn4g3 posted...

Coffeebeanz posted...

gamestunner posted...

Coffeebeanz posted...

I can see that, but some meds at 1k a pill? That's ludicrous, I dont care if they spend a trillion on development.

There are some meds that legitimately cost that much to make.

You said that, and I can agree to an extent, but that's a very miniscule amount.

I'm talking about stuff like opioids given to heroin addicts like candy, yet diabetic meds can break the bank.

Metformin and NPH insulin are super cheap. The issue with diabetes is usually compliance with meds.

Inflated diabetic meds are I think the go to in the show I was talking about, something about epi pens being 1000 times the price they originally were.

Epi pens are for allergic reactions and asthma attacks, not diabetes
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