New Illinois Medicaid Rules

[KARM12]

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Agreed. I just wonder how someone goes about doing that. There are a number of patients that would benefit from that. Do they say it's for birth control or is there some other criteria?

When I worked retail...this will be different depending on the state... the MD had to write a RX for them and it was only one random generic brand that would go through...

http://www.familyotc.com/Rugby-Premium-Condoms-12-pk-p/cd1458330.htm

I think it covered 1 box/mo...

 

[rph3664]

When I was in retail (1999-2002), Iowa Medicaid paid for some OTC meds if a doctor wrote a prescription. The ones that come to mind are iron tablets for pregnant women, OTC generic acetaminophen and ibuprofen for children, Pedialyte, and there may have been others. And I'm perfectly OK with condoms being covered, again with an RX. I regularly gave them out when I volunteered at a free clinic while I was in school, and while I realize that they're worthless unless used properly, at least they had them.

 

[rxlea]

When I worked retail...this will be different depending on the state... the MD had to write a RX for them and it was only one random generic brand that would go through...

http://www.familyotc.com/Rugby-Premium-Condoms-12-pk-p/cd1458330.htm

I think it covered 1 box/mo...

Thanks!!

 

[BidingMyTime]

All this OTC talk reminds me of how Illinois tried to drop coverage of prescription strength ibuprofen a couple of years ago (reasoning that people could just take more of the OTC tablets.) So, all the doctors just started writing for nabumetone instead, and Illinois quickly reversed their decision deciding it was cheaper to pay for prescription strength ibuprofen instead.

 

[SoylentGreen]

I mentioned this to one of my techs, who is from Texas, and she said Texas has already been limiting meds like this. Not sure if this is true because I don't work in Texas, but if it is, we should know the consequences by now.

 

[Rxnupe]

I mentioned this to one of my techs, who is from Texas, and she said Texas has already been limiting meds like this. Not sure if this is true because I don't work in Texas, but if it is, we should know the consequences by now.

Not true- Medicaid is unlimited in Texas- now they do have some Medicaid plans that are income based where a person can get 3 meds per month, but for the most part- most Medicaid plans are unlimited

 

[cycloketocaine]

Not true- Medicaid is unlimited in Texas- now they do have some Medicaid plans that are income based where a person can get 3 meds per month, but for the most part- most Medicaid plans are unlimited

Thanks for bumping a dead thread to argue yet again.

 

[rxlea]

Thanks for bumping a dead thread to argue yet again.

Mountain should come around soon. Gotta keep things exciting in SHC's absence

 

[hereticmnk]

Free condoms?! What's next, clean needles?!!!!! 🙄

State has got to do whatever is more cost effective. It is much cheaper for society to provide free birth control to the indigent family than to pay to take care of their 22nd kid.

 

[Farmercyst]

Who does the PA's in Illinois. In CA the pharmacy has to submit the PA, which means for some drugs calling for a dx. Had a pbr the other day who didn't want to "label" his pt with ADD/ADHD. Adderall is only covered with an ADD dx and so we denied filling it under medicaid. MD calls and wants me to fill it because his diagnoses of "learning disorder with hyperactivity" obviously means ADD. I told him the bean counters with medicaid didn't care if he didn't want to label his pt or not, if it's not ADD it's not covered. It's not a "label", it's a diagnosis. Geez. He relented. Doubt he actually noted the kids medical record though.

 

[genesis09]

Unless things have changed, the PAs are administered by UIC's Drug Information Department.

 

[Farmercyst]

Unless things have changed, the PAs are administered by UIC's Drug Information Department.

Who submits them for determination, physician or pharmacist?

 

[genesis09]

Who submits them for determination, physician or pharmacist?

That aspect I do not know. I interned at a pharmacy which didn't have many IL Medicaid patients and now, I work in Wisconsin.

 

[BidingMyTime]

Who submits them for determination, physician or pharmacist?

It can be either, depending on the drug. For most drugs, all public aid wants is the diagnosis--doesn't even have to be the specific code, and they will review based on that--so generally the pharmacy will call for those. For certain classes of drug and certain individual drugs, there are special forms the doctor has to fill out.