Covid-19, Poor Planning and Insurance

Just when you thought things could not get worse with the delay of care, overwhelmed and understaffed emergency rooms and hospitals, now patients can't get their medicine.

‘Somebody Is Gonna Die’: Medi-Cal Patients Struggle to Fill Prescriptions

On Jan. 1, the state handed control of its Medicaid drug program, known as Medi-Cal Rx, to Magellan Health, which is administering prescription drug coverage for California’s 14 million #Medicaid patients, most of whom previously got their medications from about two dozen managed-care plans.

“We’ve had many, many patients who are sort of in this limbo,” said Dr. James Schultz, chief medical officer of Neighborhood Healthcare, which operates 17 clinics in Riverside and San Diego counties.

“Somebody is gonna die if they haven’t already,” added Schultz, who said some of his clinics’ patients have experienced delays getting life-saving medications such as antibiotics or those used to prevent seizures and blood clots. “That’s why we’re fighting so hard.”

https://khn.org/news/article/california-medicaid-patients-struggle-to-fill-prescriptions-medi-cal-rx/

Handing over Medi-Cal’s drug program to a single pharmacy benefit manager is one of Gov. Gavin Newsom’s big health care initiatives. His administration estimates it will save the state $414 million in the 2022-23 budget year alone, in part by getting bigger discounts on drugs than the managed-care insurance plans did.

But the massive transfer has been rocky for many providers, pharmacists, and patients, especially patients who use medications their doctors consider medically necessary but require prior authorizations from Medi-Cal Rx and are generally not on the state’s approved drug list. Magellan has received more than 95,000 prior authorization requests since it took over, state officials said.

But Magellan has tripped up implementation. It didn’t anticipate that calls to its help center would take so long, and a large number of its call center workers have been sickened during the omicron surge — with 100 of 220 absent during the first two weeks of January, state officials said. Magellan also didn’t get some data it needed from managed-care plans.

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While nobody could predict omicron it seems that our politicians are constantly making poor decisions that impact the most in need. This transfer of vendors must have taken months or years of planning but like the #affordablecareact everything comes with kinks and growing pains. The key to success is to do a trial run, test the technology and shake out the bugs BEFORE, you roll such changes out. This particular change could and has probably cost patients their lives and/or unnecessary suffering.

I worked in a large corporation for 20 years. We always tested any new products. Did we have kinks, yes, but did we reduce the probability of them significantly by testing technology and products launches, absolutely. Why can't the government figure this out? If they can't then what about the teams surrounding them? Similar fails happened when the ACA was rolled out under President Obama. Only after the site crashed and after many complained about the frustration of obtaining #healthcare did the #government ask for help or guidance from #insurance company CEO's and to ask for help on the rollout. It was too late then. How do you roll out a system for millions to access at the same possible time and not test it?

This is yet just another example of how you need to be a educated consumer. When I say educated I don't mean a degree, but understand your rights and fight like hell to push through bureaucracies and poor government implementations.