Friday, July 25, 2008

Contra Costa drug shift troubles some patients

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May 30, 2006 Tuesday


By Rebecca Rosen Lum, Times staff writer

It was expected to be only an inconvenience to patients, nothing more, when Contra Costa County decided to close its three outpatient pharmacies.

But among the first wave of patients sent to commercial pharmacies are those who say they are being turned away, charged more than they can afford, and forced to endure numerous trips while desperately ill.

The public facilities are scheduled to close in July and the county is now sending patients with new prescriptions to drug stores, said Stephanie Bailey, director of ancillary services at Contra Costa Regional Medical Center.

The closures are part of a $20 million cost-cutting package aimed at balancing the budget. The shutdowns could be risky for county patients, county pharmacists had warned in recent budget hearings. The county workers filled a total of some 21,000 prescriptions a month at sites in Martinez, Pittsburg and Richmond.

Some patients say they have already experienced the consequences.

Some commercial pharmacies were not ready for the wave of new patients -- and won't be until July, when the county submits patient information via computer.

In a few cases, private pharmacies have not recognized the Contra Costa Health Plan, which covers 63,000 people including county employees and people without other insurance.

And, while the county pharmacy employees are accustomed to tracking down doctors at work or at home to fill in missing information, patients have found staffers at private pharmacies too busy, said Raphael Peck, chief of Contra Costa Regional Medical Center outpatient pharmacies.

"I've ... seen a couple come back as predicted when the form was not completed and the doctor was not available," Peck said.

Other patients can't afford the steep fees commercial pharmacies charge certain Medi-Cal patients.

Those who earn more than the minimum income the state uses to calculate benefits must pay a share of cost.

Medi-Cal has not updated its income figures since 1989: The monthly income limit is $600 for an individual and $934 for a couple.

For those who qualify for a specialized program aimed at the elderly and disabled poor, the base income rises to $1,047 a month. But if patients earn even a dollar more than that, they must pay between $400 and $500 a month, said Jeanne Finberg, directing attorney at the National Senior Citizens Law Center.

Payment wasn't an issue at the county pharmacies. Patients were not asked to pay the monthly deductible up front -- and often the county absorbed the cost, said hospital administrator Jeff Smith.

But commercial pharmacies demand the full amount before filling a prescription.

Kathy, who requested her last name not be used so she may keep her chronic health disability private, must now pay $300 a month before her medications are covered, although she brings in $1,100 a month and spends $600 on rent.

"I don't have $300," the 51-year-old woman said. "I'm sick and angry."

In recent days, Peck said he encountered the following problems:

-- Three pharmacies rejected a man with advanced AIDS and a prescription for morphine. His partner wheeled him back to the Contra Costa Regional Medical Center and pleaded with Peck for help.

-- A man taking a blood thinner to prevent strokes and clots -- "a life and death kind of thing," Peck said -- learned that the necessary insurance authorization was not in the private pharmacy's computer.

County staffers would have given the man a minimal supply until the authorization arrived, Peck said.

-- A patient with a prescription for Thalidomide, now used to treat certain cancers, went to eight pharmacies before he found one that would fill it.

Major drug store chains say they have seen a wave of new patients, but that most get prescriptions filled without problems.

"If the plan states there is a co-pay, that is the patient's responsibility," said Michael Polzin, spokesman for Walgreens. "That's partly how we cover our expenses."

A spokeswoman for Rite Aid scoffed at the suggestion that its pharmacists would not take whatever steps are necessary to locate doctors when a prescription is illegible or missing information.

"The only thing that would cause a bump is patients who are medically indigent," said Jody Cook. "That is something for the county to address, and we are asking the county for answers."

It's the county's responsibility to let Medi-Cal patients know private pharmacies will not absorb the cost of deductibles, she said.

Picking up the cost of a monthly deductible "is something the for-profits are never going to agree to unless the county pays them more money," said Michael Keys, staff attorney with Bay Area Legal Aid. "In which case, why would the county have cut their pharmacies?"

While state law requires counties to provide health care, including medications, to the indigent, counties are increasingly contracting with private providers to meet their obligation, said

Often, it's a move that winds up costing as much as it saved, Keys said.

San Francisco General Hospital radically cut back its pharmacy about three years ago, but has reinstated it.

"The savings never happened," Keys said.

No patients should be falling through the cracks, said Bailey and the chief of the county's health plan.

The health plan already has a relationship with some 100 private pharmacies, said CEO Rich Harrison.

Despite the complaints from patients and the doubts of the county's pharmacists, Harrison said he has heard no complaints.

As part of the transition, emergency room patients are leaving with a starter pack of medication, and a prescription, to cover the period after their release.

The county can't afford any longer to provide care and charge for it later, Bailey said.

"That's how we ended up in the position we're in," she said.

Rebecca Rosen Lum covers county government. Reach her at 925-977-8506 or rrosenlum@cctimes.com.

WHERE TO FIND HELP

People with problems getting prescriptions filled at commercial pharmacies can call:

-- Protection and Advocacy, 800-776-5746. Can help with Medi-Cal share of cost and other problems

-- Contra Costa Health Plan Member Services, 877-661-6230 option 2. Can steer members to local participating pharmacies

-- Contra Costa Health Plan or Basic Health Care Financial, 800-771-4270. Counseling.

-- Health Insurance Counseling and Advocacy Program HICAP, 800-434-0222. Assists families and individuals with Medicare and other health insurance.

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