Dear Brian and Roy and fellow JAMA, MMA, and Pediatrics tossers: Sure Pediatrics is a good journal if you want to read 50 articles on the art, oops, EBM of treating hyperbilirubinemia.
I have over 50% Medicaid (Mainecare) in my practice. I really don't have a choice given my starting practice. Maine, home of the most Medicaid per capita in the country and the proud home of the $50,000,000 computer claims debacle where no doctors got paid for months and months as the claims were sucked into a big hole.
It is frustrating, because they do tend to be the most demanding. Not sure if other states of the Preferred Drug List, but it is a nightmare. While the intentions are good, it is super frustrating to finally be allowed to use Focalin XR but only then to be told how much we can use, i.e. can't prescribe more than 36 mg without a Prior Authorization. Take a look at one of the following criteria from Maine's Preferred Drug List. See if you can understand it, and try to imagine going through it in a ten minute office visit.
Seroquel 25mg is preferred and available without PA if the following conditions are met: a.) Either 65 years of age or older or less than 18 years of age, b.) dosage is for 3 or more per day, c.) Seroquel 25mg is in the profile within the last 45 days OR if any of the following doses are being used in combination with any daily dose of Seroquel 25mg: a.) at least 1.5 Seroquel 100mg tabs, b.) Seroquel 200mg tabs, c.) Seroquel 300mg tabs, d.) Seroquel 400mg tabs.
So, you know what I do? I write for 25 mg in the AM and 400 mg in the PM and tell the patient to throw away the 400 mg tabs.
But, I figure it's not the Medicaid patient's fault. It's, as usual, the federal government. If someone handed you the keys to a BMW 330xi, would you turn it down?
And, a bit off topic. Look what happens when 30,000,000 people want something. I am referring to the 14 year old to 21 year old young people who started with the illegal Napster and Morpheus and Limewire, which resulted in 99 cents songs from iTunes, etc.
Where are physicians? We are sitting on the medical ward with a very sick patient going through PubMed and finding the perfect article on the workup and treatment of secondary hyperparathyroidism only to find you can get it instantly through Springlink for the discount price of $35.00. And, that's for one day! And, that is supposed to decrease healthcare costs.
