The Hell of Medicaid part D

The Hell of Medicaid part D
By Mike Reynolds.

Journalists are supposed to be objective, yet it is impossible for me to have any objectivity over the new prescription drug plan offered as part of the new Medicaid part D coverage. As an individual with a disability, I knew this was going to be a bit of an adjustment. The difficulty I experienced, however was totally unpredictable. I feel I did have some benefits; my best friend is a technician at the pharmacy where I get my medications. I have worked in the insurance industry, and I would like to think I advocate for myself effectively. All of these assumptions would be tried in my mind in the month of dealing with part D.

I should preface this with the fact that I did go through a medicine change that was unexpected and unrelated to Medicaid. I am disabled due to Cerebral Palsy (CP) and also have a diagnosis of Panic Disorder. The CP is due to a difficult birth, my Panic Disorder was diagnosed when I was 15, though I know I have had it from a very young age, I think my first panic attack was at 7, which wasn’t considered plausible when I was growing up. I need various durable medical items to get through the day, but since this law did not affect DME, there is no need to really discuss the entirety of those needs.

I tried to get a drug I was out of on December 30th. But there were some complex issues with my doctor’s office, the drug was never refilled, and I found myself without it for a week. This drug was a form of neurontin, which I was taking for post surgical pain and spasms, which had been treated with physical therapy. I had some of my Lexapro, which I had used for years to help with my anxiety issues, in conjunction with a script for klonoprin, a drug I have been on since I was 17.

On January 3, I went to go get my klonoprin refilled. I had my part D card from a company, which, I guess was better than some folks, who did not even receive any information in the mail. I also have since learned that this was the program the government threw me into, without looking at my medicines at all. My friend informed me that no drugs in the same class as my klonoprin were covered by any plan. My neurontin drug was to be picked up at my doctors office as it was also, not covered without some lengthy paper trail. This had already taken a couple of hours, and as I was going home, my friend called my cell phone and let me know that my Medicaid was also somehow cut off. This was more than 2.5 hours after “just trying to get a script refilled.” It took an hour to go to the Human Services office and get my Medicaid re-instated. It was discontinued due to a computer error. I received a letter and was told by the pharmacy I could get my drug refilled in 3 days, luckily I had enough to last those 3 days. I went home exhausted, physically, spiritually and mentally. I am usually a pretty resilient person, but this had left me wiped out. I was left wondering why part D didn’t pay for meds I needed to stay sane. Was I some sort of horrible person for needing the medication? Was it a frivolous drug expense? I went to sleep early, my partner looking in on me, as I seemed a bit distressed.

The same week my body went into crash mode, or just basically deciding it would not cooperate with what a 32-year-old body should do. I had lost bowel control, something that has happened before but after the third day of “oops,” my partner decided that maybe an ER visit would be advisable. I had no idea why my lower half of my body just stopped and said to my brain “He, you thought you had control of us, eh, well, we’re rebelling, and you can’t stop us.”
The ER visit sucked, most do, but this even more so. Instead of my neurological impairment being the main focus, my sexual preference was somehow more important. The ER attending ruled it a bout of diarrhea, a dubious diagnosis because I know my body, it wasn’t that, but after four hours in the ER, I could care less, I just wanted to go home.

I decided to see my general doctor. He was on vacation, but I got a script and the need to try and get on a bowel program seemed to iron things out. My doctor came back and decided to change my anxiety meds to see if a different combo worked. It did, but a bit too well; I was constantly tired and stopped after a couple weeks.

My disability does have some effects on my body that are less than desirable, but after the runaround I have dealt with part D of Medicare, I cannot see how this drug benefit really helps anyone except insurance and drug companies. I mean I am glad I have coverage, and I am glad Maine is one of the states that made sure that there was some stopgap protections. Certainly I cant be the only one with these problems, but after the amount of bureaucracy, I can only imagine how other people who may not have the education or background, or a good friend who knows the benefits from working in a pharmacy and was helpful enough to tell me that my Medicaid was cut off, which probably saved me time by getting it all done in one day. So I guess I’m frustrated, but overall, not hurt by Medicare part D. I just hope they don’t plan on doing this to DME supplies or it will be an enormous headache.