Where does the sense of entitlement come from with some Medicaid patients? If you are indigent, out of work, down on your luck, I understand. Times are tough, jobs are scarce, money is tight, people need help. I get it, really. If you appreciate what you have, and don't abuse what you are given, great. This taxpayer appreciates your appreciation for what you have. However, it is the ones who don't try too hard to get a job, are content to be lazy, and don't realize how fortunate they are to live in a country that has Medicaid programs that seem to take medical care for granted. They are here, instead of a third-world country, they are blessed. (I am talking about all people, not only immigrants)
I never cease to be appalled when I speak with these patients. I do my very best to be informative, helping them understand the process for Prior Authorizations, but all they seem to hear is this: YOU CANNOT HAVE YOUR MEDS, I KNOW BETTER THAN YOUR MD DOES. These words never, never, ever come out of my mouth.
I have been threatened with lawsuits countless times and I never take it seriously. You see, they can threaten me all they want, the bottom line is this: we are not refusing you all medication to treat your condition, only a certain one which requires additional information on previous meds tried. (this statement does come out of my mouth) Yes, cost is an issue. We cover many drugs that have been used for years successfully, are generic, lower cost, and we just need to know if you tried one, whether it helped or not. Just because a drug is new on the market, is Brand only, and is expensive doesn't mean it will work for you. It only means just what the description states. Why not try a drug that has been around for years and has worked on thousands of people? To me, this is good prescribing sense however, drug reps are pimping medication to every MD in the U.S. so that has an influence in varying degrees depending on the MD.
If your MD doesn't want to submit a PA, fine, have them change the medication. I CANNOT MAKE YOUR MD SUBMIT A PA!!!! If you want them to do so, please bug them-incessantly if they are not receptive.
Final Statement: Treating a patient's chronic condition is usually a process of trial and error. Period. There are very few "Cookie Cutter" treatments available.