We are very pleased to have Erica Rothschild, Community Organizer at the Gay Men’s Health Crisis, appear as a guest blogger today. This is part 1 of 2 in Rothschild’s efforts to show how taking prescribing authority away from doctors has a devastating impact on patients.
Remember the good-old days? You go to the doctor, she prescribes the appropriate regiment for your health, you stop at the pharmacy, pick up your meds and head home. In those good-old-days, you placed your trust in the hands of the prescribing physician. Exactly where it should be.
Not anymore. With the Medicaid redesign in last year, patients’ needs now take a back seat to the world of Managed Care. The power has shifted from your physician to a bureaucracy that cares about saving money and not about your sustained good health. The challenge is simple: The redesign creates a maze of red tape, creates lengthy and (potentially dangerous) administrative processes, and puts patients’ health at serious risk.
Don’t take my word for it. Listen to Max.
Since October 2011, Max has been on Fidelis. As a multi-drug resistant person living with HIV, he has been working with his doctors for years to find a drug combination that works. About five years ago his doctor discovered that, though an unorthodox mix, the combination of Intelence and Lexiva was the best drug regimen for this complicated multi-drug resistant patient. Since then Max has had regular access to medication, same day prescriptions filled by his pharmacist, and the correct dosages. In these five years he has become undetectable and brought his viral load down to 20. With his progress, he went back to school with the goal of receiving his degree and getting back into the work force.
In September 2012, Max’s insurance changed from fee for service to a Managed Care plan. This change had immediate unexpected consequences. His regular drug regimen was denied by the Managed Care plan and he had to go through a series of prior authorizations and appeals to maintain access to his medications. Max spent endless hours on the phone trying to talk to the manager, manager’s manager, and any person at Medicaid who could help him access his much-needed medications. “It became a full time job talking to them on the phone, and I came out empty handed,” Max recalls. He appealed several times and worked within their system to regain access to his medications, but has not been on Intelence since September. They did approve Intelence for December, but then denied it again for January. His viral load has been steadily rising.
But that’s not all. Max uses breathing pumps and keeps waiting for those, too. “They’ve denied me breathing pumps,” he said. “Breathing, you know, that essential thing in life, like water. They’ve denied me the ability to breathe.”
Even worse, in addition to Max’s physical health depleting, his mental health was compromised from the fatigue of dealing with countless hours of phone calls with unhelpful Medicaid representatives. He no longer had the strength to pick up the phone, even for family members, and could not leave his apartment for 9 days. He also dropped out of school and put his career aspirations on hold.
With trust now relocated to the hands of the Managed Care plans, many people’s medication regimens have been disrupted. Patients need to wait for prior authorization to receive medications they have been taking for 5+ years or have to substitute their doctor’s prescription with a less compatible and less effective option. The harsh effects of this loss of protection have hit the HIV/AIDS community hard. Between drug resistances, histories of drug failure and the increased susceptibility to infections, people living with HIV/AIDS have tirelessly worked with his or her doctors for years to find the drug regimen that best benefits his or her body. This change does not allow patients to access the care they need, and the progress individuals have made over the past 20 years is beginning to regress under this policy.
Stay tuned for Part 2 from our guest bloggers, Gay Men’s Health Crisis. For another example of how this policy has caused detriment to patients, check out this video.
-Jaime Venditti, 2/20/13