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Wednesday, April 14, 2010

OTC products on Medicaid

I'm not sure how laws work in other states regarding what is and is not covered on Medicaid, but our OTC stuff being billed on there is about to drive me up the wall. We have actually ordered pint stock bottles of acetaminophen, ibuprofen, and diphenhydramine elixirs/suspensions JUST for Medicaid. I know that they are dirt-cheap... but that's the point! They are dirt cheap! Let the boogers get their $2.00/120mL bottle of generic Benadryl on the regular counter! I think it probably costs us more in labor to do the damn Rx than we are making on it. I can ALMOST get along with the loratadine prescriptions, since it is 6 or 7 bucks out there, but still grumble a little every time I have to pour that stuff up.

Maybe I'm just not a fan of seeing the system gamed, or maybe it is objectively ridiculous to bill cheap OTC's to Medicaid.

This post, by the way, was inspired by me having to send a refill request to someone's MD for acetaminophen elixir today - we didn't hear back on it, but if I worked at the doctor's office, it'd be fairly low priority for me also.

And maybe I'm cranky because it's day 3 of a new workout regimen and I'm sore. Who knows.

TAP has a post about a very similar topic from a few months ago as well.

--Fries With That.


Michael said...

They're generally covered for children under 10 here, and I don't really have that big of a problem with it. I'd rather a child's med be covered over an adult's any day.

Anonymous said...

We have a few patients that get OTC's covered on their insurance, so our solution is to just walk out behind the counter to the front store and grab it off the shelf. Problem solved.

Dromedary Queen, Ph.Tech

McFury CPhT said...

I agree with both points. I don't mind filling for children, heaven knows their parents wouldn't dare buy something needed for their child. However, I have issues when it is for a healthy (more or less) adult.

When I was in Florida they would cover up to $25 of random OTC crap. Diapers, formula, etc. I'm sorry, but if you can't afford the accessories you shouldn't have the toy to begin with.

Anonymous said...

Not that it has anything to do with Medicare, but I (veterinarian) will often write a script for an otc med so that the client is sure to get the right thing. When I haven't done this, the client gets something similar (or not) that they think is ok. If I don't write one, I have the client come back with it so I can see it.

Anonymous said...

Don't breed them if you can't feed them.

Frantic Pharmacist said...

We spend far too much time and effort screwing around with prescriptions for OTCs. My favorite one the other day was petroleum jelly. When you count in the time and labor, it's the most expensive damn tube of petroleum jelly ever.

Jerome said...

I'm not calling for refills on otc's, with the possible exception of loratadine or cetirizine. I have to many moms of young kids coming in for refills from months ago, who can't really tell me why they are refilling this now. I tell them call your doctor and see if the kid needs to be seen.

Rose said...

I have an OTC med prescribed (I'm in the UK), but the main reason is that otherwise you can only buy about 16 tablets at one time. Since I take 8 a day, I would be at the pharmacy a whole lot.

In the UK we have a fixed cost of about £7.50 you have to pay per prescription unless you are a child, on welfare, etc. But I pay about £110 every year and that covers all of mine for the year, under a scheme they have for people who need a lot of different medications.

The main reason I have it prescribed is because I can get a bigger box, but as a side benefit I don't pay any extra for it because all my meds are covered anyway.