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Question:

From Miami, Florida, USA:

My cousin has had diabetes since she was eight years old. She has to take four shots a day. She has Medicaid, but they won't pay for her medicine or syringes. At times, she can't pay for her medicine so she goes days without it. I thought that if it were medically necessary, Medicaid would pay for your medicine. What can she do? She's paying $100 per bottle of insulin and $20 per box of syringes.

Answer:

I am not an expert on this but I can relay my experience from South Carolina. Things might vary from state to state.

In South Carolina, we were often told by families that their pharmacy wouldn't/couldn't/refused to fill prescriptions sometimes for glucose meters or the meter-appropriate glucose test strips, ketone strips, and sometimes even "insulin." Parents would call incensed and scared. What we often (I hesitate to say "always" but maybe it was) found was some miscommunication or a little razzle dazzle on the part of the pharmacy. The razzle dazzle was particularly noticed about the filling of glucose test strips. We might prescribe a specific "name brand" glucose test strip to go with the glucose meter, but the pharmacy folks would say that Medicaid wouldn't fill. This was, of course, UNTRUE. Rather, we found pharmacies, usually small ones, that would push the store brand or generic meters/strips because they lost money on the Medicaid reimbursement for the brand-name materials. When we confronted them, they filled the prescription.

As for insulin and syringes, the question writer may be correct or there may be miscommunication. South Carolina Medicaid began to stop paying for insulin pen devices and their needles, but still easily paid for insulin vials and syringes. If that (or the converse) is the case for the question writer's cousin, there may not be anything that can be done other than learn to take insulin by vial/syringe or by pen, as necessary. Of course, they can pay cash.

DS

[Editor's comment: Your cousin may wish to contact the Partnership for Prescription Assistance. BH]

DTQ-20081027204319
Original posting 9 Apr 2009
Posted to Insurance/Costs

  
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Last Updated: Tuesday April 06, 2010 15:10:18
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