Medicaid Mary and a $4 Prescription

How did things get so bad so quickly in our nation? How?

A patient of our Goofmart Pharmacy presents a prescription for Xanax on a busy Friday afternoon. We get a lot of people preparing for their weekend by dropping off narcs and sedative type prescriptions on Friday (despite the fact we're clearly open Saturday and Sunday).

This patient is Medicaid Mary. You might have read about her before here. Her script is for a small quantity of Xanax. The floater tech processes the prescription but it won't go through on the insurance. The rejection looks like she has to go to a specific pharmacy so the tech runs it through on a discount card we use. The cash price is $4.45. That's certainly cheap enough for most everyone.

Among the chaos of phones ringing, people picking up and dropping off, and filling prescriptions Mary's prescription makes it way to the window where another tech tells her that the insurance isn't working but that it is only $4.45. Mary opts to pick up the medication. All is good with the world, right?

Wrong.

An hour later Medicaid Mary's insurance calls. The lady demands to speak to the pharmacist, so the tech hands her over to me. The lady is quite snotty and belligerent. She tells me that Medicaid Mary called and she's upset and that we didn't process the prescription correctly because it is covered in our pharmacy. I try it again. Same rejection, so I start getting belligerent back with the snot-nosed witch on the phone. I tell her that it isn't working and that when THEY fix it I'll try it again. I then tell her I'm busy helping OTHER patients and don't have time to fiddle with a freaking four dollar prescription. I tell her I'll put her on hold while I go be a pharmacist and help the patients with insurance that works.

By the time I get caught up ten minutes later she, of course, had hung up. You see, you wait for insurance on the phone -- they don't wait for you. So you'd think this is over, right?

Wrong.

Ten minutes later one of the sub commanders from the front of the store appears at the pharmacy. He's holding a piece of paper and says that a "customer" is on the phone demanding that he get the following information (BIN, PCN, Group, ID... all the pharmacy goodies that make a prescription process) for Medicaid Mary. After a couple of questions I determined that it is NOT Mary on the phone. Rather it is snot-nosed witch that called the front of the store and demanded that the sub commander go get this information from me.

I don't know about you... but this is the FIRST time anything like this has ever happened to me. What kind of Medicaid insurer calls the grocery and demands information?

I tell the sub commander, all of about 17.5 years old, that he's not HIPAA certified and that I can not and will not release that information to be walked to the front of the store and disappear. I tell him that snot-nosed witch is NOT a customer and if she wants the information to call me. 

"But she said you were mean to her. She doesn't want to talk to you."

I laugh inside. Mean? This is a good day. You should see me when I'm really in a bad mood.

"She needs to talk TO the pharmacy. If she wants the information, she needs to talk to me," I reply. Sub commander walks away. His brainwashing isn't complete yet so I still have some power over him.

Snot-nosed witch finally calls again. I verify the information with her. She fixes something on their end and the prescription processes. Co-pay for the patient? 45¢ Yep. We charged her $4.45 and now owe her a whole whopping $4. I call Mary and tell her we owe her $4. You'd think she'd come back in a few days to get her refund, right?

Wrong.

Within thirty minutes here is Medicaid Mary to collect her $4 refund. Oh, I imagine she probably spent $1 in gas driving to the pharmacy and back based on her address, but that's irrelevant. $4 is $4, and we're certainly not going to let the pharmacy have that $4 overnight.

So... five or six phone calls, multiple people involved, time wasted by me, snot-nosed witch, the sub commander, and my tech all over $4... a Medicaid prescription that taxpayers pay (a WEPAY). This is yet another example of government bureaucracy out of control that costs all of us multiple times over. And because it's not my money directly, you think I should be ok with all of this?

Wrong.