Guest guest Posted June 15, 2011 Report Share Posted June 15, 2011 Hi Chantelle, I have had a number of go-arounds with the Springfield-based, 3-ring circus called Medicaid. My son turned 21 recently, and is now no longer eligible for a prescription for OTC acid reflux meds he was prescribed (Prilosec).. Pretty incredible---on a Friday...'we are all about maintaining your health'....comes Saturday....'you are now too old for us to care about maintaining your health. The monthly cost to us would have been $75-$100, depending on the sale-of-the-month. May not seem like a lot of $$,..to some people. 2 options available that I know of: - Investigate, with the prescribing MD if there are any meds that Medicaid will cover that are similar to what he is on now..there are a variety of reasons why that can cause more problems than solve. Not much of an option, but worth a shot. - Have your MD write a 'letter of medical necessity', containing ALL pertinent info about your son's case, previous meds tried, success with current meds regimen. The letter needs to contain Medicaid case#, ID#, etc.--fax to 217-524-7264. This is not a quick process, but if plan A above isn't acceptable this is your other choice. We are currently trying this route for my son's acid reflux meds. We are fortunate to be working with an MD who understands how the system works (Suburban Gastroenterologists). Some years back my son was taking Strattera, and when he turned 18 the state wouldn't cover (over $1,000/month or some such obscene amount). MD wrote the letter, state denied it (could NOT have seen that coming!), and we tried him on a similar covered med...similar results were achieved. Good luck navigating the swamp that is public aid. Al Karman On Wed, Jun 15, 2011 at 10:04 AM, chantelle <cappy.porter@...> wrote: > > > Thanks for all the input on guardianship. Wouldn't you know just yesterday > I received the paperwork from the court (Dupage) that I need to complete for > continuing guardianship. It was sent by a volunteer. I didn't even know they > had such a thing. At least the " free help " is on top of things. > > Yesterday Zack was also approved for Medicaid. The statement he received > wasn't on any kind of letterhead, no signature, no date just said " you're > approved. Your card is in the mail. " Of course, I suppose since it doesn't > pay for much of anything there's no reason to worry about it looking > " official " . (Seriously, it looked like a stalker could have sent it) It's so > absurd it's funny. > > On another note, Zack's Medicaid doesn't cover 2 of his prescriptions. > (They're $280 a month) Anyone had any luck with the Patient assistance > programs that the major pharmaceuticals offer? Any tips? > > Thanks > > Chantelle > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2011 Report Share Posted June 15, 2011 Your doctor can file an appeal to Medicaid - stating nothing cheaper, no other drugs & no generic drugs work for him. From: chantelle <cappy.porter@...> Subject: Guardianship, etc IPADDUnite Date: Wednesday, June 15, 2011, 10:04 AM Â Thanks for all the input on guardianship. Wouldn't you know just yesterday I received the paperwork from the court (Dupage) that I need to complete for continuing guardianship. It was sent by a volunteer. I didn't even know they had such a thing. At least the " free help " is on top of things. Yesterday Zack was also approved for Medicaid. The statement he received wasn't on any kind of letterhead, no signature, no date just said " you're approved. Your card is in the mail. " Of course, I suppose since it doesn't pay for much of anything there's no reason to worry about it looking " official " . (Seriously, it looked like a stalker could have sent it) It's so absurd it's funny. On another note, Zack's Medicaid doesn't cover 2 of his prescriptions. (They're $280 a month) Anyone had any luck with the Patient assistance programs that the major pharmaceuticals offer? Any tips? Thanks Chantelle Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2011 Report Share Posted June 16, 2011 Chantelle: I have had good results from the prescribing physician submitting a letter of exception (an appeal) to Medicaid, to get meds paid for that are not on the formulary (approved drug) list. As I recall, there is a specific form. Sherri Schneider might chime in, as she would know about this. We did it quite some time ago. From what I hear, the same kind of process is available to those of us whose loved ones are part of the Managed Care programs. Ellen Ellen Garber Bronfeld egskb@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2011 Report Share Posted June 16, 2011 Apologize for my late response...thanks Sherri and Al for covering the topic of appeals to Medicaid for meds. Funny, Al...I think it was Straterra that we appealed, as well, but, we got it approved...go figure!!! Ellen Ellen Garber Bronfeld egskb@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2011 Report Share Posted June 16, 2011 I have found that it depends on the wording of the appeal. It is important for the dr to notate that other drugs will not work and generic will not work. The specific drug was initially denied because it is not on Medicaid's formulary list. (most of the time, this means it is too expensive). So the dr needs to explain why this particular drug is the ONLY one that will work for his patient. From: ELLEN BRONFELD <egskb@...> Subject: Re: Guardianship, etc IPADDUnite Date: Thursday, June 16, 2011, 8:49 AM Â Apologize for my late response...thanks Sherri and Al for covering the topic of appeals to Medicaid for meds. Funny, Al...I think it was Straterra that we appealed, as well, but, we got it approved...go figure!!! Ellen Ellen Garber Bronfeld egskb@... Quote Link to comment Share on other sites More sharing options...
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