I was part of a trial medicaid program last year that was based on a PPO model. For the most part, I didn't have any major coverage problems (only one of my scripts wasn't covered and had to be paid out of pocket). Others did though, and the program was dropped and I was moved into general medicaid last month.

I tried to get my prescriptions refilled last week. My prescriptions were rejected because medicaid won't cover them.

The reason?

The scripts were for generics and medicaid will only pay for the more expensive brand-name pills.

Ridiculous.

My brother has Cystic Fibrosis and racks up quite a bill through both Medicaid and Medicare. I believe they charge Medicaid retail/hospital prices from looking at the bill, although some of his medicines are specifically designed for his various health problems.
He had to be declared disabled to qualify for all this once he reached the age of 19, so he receives an SSI check as well. Except for a yearly hospitalization for about two weeks, he can function in a normal work environment on a full time basis.
It does seem very ridiculous, when they could save a bunch of money by making more generic equivalents and solely covering his health care.

But medicaid will pay if the doctor prescribes the name brands? If so, it's better for you.

I'm assuming you're for some form of government based health care reform. Wouldn't this be evidence against it?

Have you tried Canada? Toledo is pretty close.

it's a classic lobbyism problem.

Medicaid will pay for name brands, but not generic equivalents. Most research suggests that there is no substantial difference between the effectiveness of the two. It is not 'better for me'--seems like its better for the drug companies.

Of course I'm for health care reform, and I do think that government has a role in it, and should find ways to extend their coverage to those who cannot get it otherwise (such as someone like me with a pre-existing condition).

Its dumb to assume that just because I think the government should be more involved, I want them to do it in ways that most Americans would find asinine.

Run a poll of Americans and ask them "Should Medicaid only pay for name brand meds when generic equivalents are available?" They're going to say no. Its common sense, and the fact that medicaid doesn't just shows that drug companies have way too much say in our health care policy.

politically, it's the problem that there are drug companies who spend a lot for research and there are others, free riders, who buy the licenses after the patents have expired. for that these drug companies with the "brand name meds" try to gain their political influence. we had the same problem here, it's only to solve with a law.

mugwump - I believe Target, Wal-Mart, Kroger, etc. are now providing CERTAIN generics for $4.

Here's a brief list of prescription saving plans - http://clarkhoward.com/topics/prescription_plans.html

My neuro (whom I've been with for 13 years and trust implicitly), tells me that the variance in actual medicine dosage is significantly higher for generics than it is for brand-name. (FDA allows name brands a ±5% variance in dosage; generics: ±40%).

For seizure meds, that kind of variance is not acceptable and could have serious repercussions. So he keeps me on the name-brand.

The opposite side of the "name brands = greedy bastards" coin is, of course, that generics don't create any new drugs, and can in fact only exist in a market where someone else spends 7 years and $100M+ on average coming up with the one that works (along with 25 others that didn't), so that they can then quickly begin copying it. Somewhere between the two is the sweet spot where no one gets ripped off but research still happens, but how do you legislate that?

There's no denying that the current setup leaves a lot to be desired.

For clarity's sake: I'm still getting my meds through medicaid, the doctor just had to okay the change.

At retail prices, Medicaid shelled out at least 4 times what they needed to. It amounts to over 600 dollars EVERY MONTH. This alone would pay for Promethius's brother's SSI check and then some.

I'd be more than happy to accept generics if it meant that 3 other people who didn't have coverage could get their meds.

The target and wall-mart plans are great, but none of my meds are on the list. Even generic mental health meds are too expensive to expect them to be offered.

I don't know your doctor, but I think a variance of 40% is put way to high. generics are actually nothing more than the same med as the brand name but the patent run out so others can produce and sell it.

Yeah, writing that out, it don't look so right to me.
Again... 13 years and he is the only guy that has been able to get a handle on my MS and also caught my cavernous angioma before I started having either seizures or an aneurysm. I trust the guy. Period.
But I do have to look into that because, out-of-pocket it's
$350/month vs. $5/month... and he knows it.

these big brand name companies are quite nice to doctors here, a couple of years ago there was this scandal about the deal: you prescribe our med and you get a trip for 2 weeks for your family on something like love boat. in a way I can understand the docs.

the only way is a law that a doc must prescribe generica when available and comparable in effectiveness.
another problem are hospitals, they have another different deal.

It's not dumb to say that if you want government sponsored health care but you're complaining about how the government handles it's role in health care presently, then you're sort of contradicting yourself.

I understand that in a vacuum you can demand that government do this correctly. But in reality, most people don't like governments tendency to be horribly inefficient and have stupid rules that defy common sense for the sake of stupid rules. It's not a stretch to say problems like yours are a hallmark of government run programs.

If we're discussing vaccums, there's a dream world where private companies and free markets cover almost everyone.

Generics vs. Name brand. My only real point is you're not really being harmed by the situation. Generics work just as well but there can be some subtle differences that you don't have to worry about since the US government is paying for name brand.

For the record, I'm for some reform and some government involvement. I'm just not sure what exactly.

So glad you went "on the record" --we'll be holding this all against you at a later date.

The obner record is very important.

I'm not sure why I'm contradicting myself if I think these programs are needed, but they need to be fixed. If there's a logical flaw there, I can't see it.

I do think that it is a logical flaw for someone to conclude that a stupid rule invalidates an entire program.

Who's saying that?

care to elaborate on this figure? cause I find it hard to beleive you

generic medicines are THE SAME in 99% of the cases

even for things like antiepileptics and anticoagulants (low therapeutic index) there is minimal risk in being on a generic - although often doctors will often prescribe the brand name for these sorts of things

this is a pretty complex issue

countries like NZ where doctors are pushed to prescribe generic drugs are generally seen by the big drug companies as freeloaders

the big drug companies make almost all their profit in the US

laws surronding patents are somewhat tricky for drugs

a new drug usually needs to be patented early in development but as late as possible. due to federal requirements for testing after further inhouse development, by the time a drug makes it to the market half the patent life is gone

additionally they will develop many similar drugs with only one making it to the market, so theres a lot of $$$ involved

its not all bad for the drug companies, when they get something big to the market like Viagra profits are ridiculous.

because of the above factors drug companies pour huge amounts of money into lobbying in the US

the answer really is just to extend patent lifespan for novel drugs

not true actually. us law only mandates that the drug be 80% to 120% as potent as the original, even though it has to have the same exact drug. sometimes the delivery system is changed a little

for most drugs that is sufficiently accurate and there will be no difference in effect..so for these purposes they are the same

drugs with narrow a narrow therapeutic index are a different story sure

im must saying they dont have to be the same as far as bioavailability is concerned. i notice the difference between generic and trade IV meds that I give in the operating room, and while i believe that generics are equivalent, there is always the chance that there is a significant difference

they pay it with your taxes.