Cover the Uninsured Week March 10-16 - page 4

As some may have heard or read or seen on TV in the form of informational commercials, in the United States, there are 41+ million people who are not covered by health insurance. As the commercial... Read More

  1. by   kids
    originally posted by maureeno
    from the oregonian
    man's state points to crisis
    03/09/03
    patrick o'neill

    a disabled portland man is unconscious and in critical condition at legacy good samaritan hospital & medical center after losing state pharmaceutical benefits for low-income people.

    douglas k. schmidt, 36, apparently suffered a massive seizure about eight days after his supply of anti-seizure medication ran out.

    family members said saturday that schmidt was still waiting for an application to arrive so he could get onto one of the interim prescription programs being offered as backup by pharmaceutical companies. ...
    (edited down article to save space as it appears twice previously-kids-)

    i have never been a fan or defender of ohp (oregon health plan)...and i am not going to start now, however, i live <20 minutes away and this has seen a lot of local news coverage. imho it is unfair to simply dump it on ohp that they just up and stopped paying for the seizure med so this man had a major sz and is now in a coma. even from the sympathetic bend of our local news casters there seems to be a degree of or lack of personal responsability here also.

    the drug that was no longer approved is lamictal.

    2 statements i heard/saw his mother make on local tv news:
    (he was) was notified on the first of january that the medication would not be covered after march first.
    (and she said) "if he had told me he had run out i would have found a way to pay for it".

    the agency that i left in january also has 2 oregon offices. the neuros on their cases were also notified that it would not be covered, they neuros and their patients were given 60 days notice so that attempts could be made to wean the patients on to other drugs or to document unsuccessful attempts. when this story broke i spoke with a former co-worker about it: 3 cases had obtained waivers from the ohp for the med because of unsuccessful weaning, a 4th is paying for it out of pocket and pursueing assistance from the manufacturers program.

    i am not sure what is meant by the statement "family members said saturday that schmidt was still waiting for an application to arrive so he could get onto one of the interim prescription programs being offered as backup by pharmaceutical companies".
    the manufacturers program (copied from: www.needymeds.com and pasted below) does seem to be somewhat of a pita but it does not appear to me to be anything that could not be acomplished in a 60 day period especially if you consider that neuros all over the state of or (had to be) scrambling to get people enrolled in the program.

    pharmaceutical company glaxo wellcome inc.
    program address glaxo wellcome, inc.
    patient assistance program
    po box 52185
    phoenix, az 85072-9711
    toll free phone number 800-722-9294
    fax number 800-750-9832

    guidelines and notes: this continues to be a complicated and tedious program for advocates who do not have regular consistent contact with patients because of the extent of provider involvement required -- patient advocate must be the liason between the program and the patient. . even though glaxo wellcome merged with smith kline beecham to form glaxo smith kline, they continue to maintain this program under this name for now. call monday through friday 8 am to 8 pm eastern time. program is designed to provide short-term assistance. patient eligibility depends on patient's household size, income and medical expenses.

    initiating enrollment: patient advocate must call to register as advocate and to pre-enroll patient. patient advocate can be any professional willing to serve as liaison with company on behalf of patient on a regular basis. they will send forms that cannot be copied, but advocate must call to register every patient if patient is eligible they will activate card on second page of form so patient can obtain an immediate 30-day supply of medication and then send in form.

    health provider's role: doctor completes, signs the form. gives patient 30 day prescription to take to the pharmacy with card. for subsequent supply,

    patient's role: patient signature required. income and financial information also needed on form. company will request proof of income and copy of picture id after initial application received. patient needs to complete and mail form after initial telephone enrollment and doctor's signature and portion are completed.

    how dispensed: patient uses card along with prescription and $5 or $10 co-pay to obtain medication at the pharmacy. advocate must call before each prescription will be filled.

    amount dispensed: 30 days, then two additional 30 day supplies of the product. patient must submit additional income and insurance information to be approved for additional 90 day increments.

    refills: company requires additional written documentation of financial status and a follow up call from designated advocate before they will authorize refills. .

    limit: indefinitely

    i do not want to come off sounding unsympathetic to the uninsured in any way. my children and i were uninsured for 4 years because dispite making an rns wages, affordable insurance was not available from my employer. we got by, but only because i had a good relationship with my kids doctors and dentist and when i made payment arrangements i kept them. somehow i managed to pay for well child visits, preventitive dentistry, sick visits & abx, 3 broken arms (2 in the same week) and a 4 day hospitialization for pneumonia.
    Last edit by kids on Mar 11, '03
  2. by   RNforLongTime
    Well Susy, Sally may not have said that (about the virtual posse) but she agreed with the person who did.
  3. by   NRSKarenRN
    Please keep this thread on the topic addressed. Thanks.
  4. by   Sally_ICURN
    Wednesday
    3/12/2003

    "Dr. James Dwyer, a professor at the Center for Bioethics and Health Law and the associate director of the Consortium Ethics Program, used his time to discuss the moral and ethical case of the uninsured dilemma. He said as a society which values justice, America needs to provide healthcare opportunities for everybody. He added that Americans should re-evaluate their sense of responsibility to improving society.

    'We live in a society that overemphasizes individual responsibility and underemphasizes social responsibility,' he said."

    http://www.pittnews.com/vnews/displa.../3e6ed3c687149

    It strikes me that of the list of organizations, etc. that are supporting attention to finding solutions to covering the uninsured, that noticibly missing from the list are pharmaceutical companies, HMO and Managed Care companies, and health equipment companies. What does this say about the priorities of this country's money making businesses that are, in large part, the suppliers of our care?
  5. by   Sally_ICURN
    Originally posted by Gardengal
    I find it interesting that the AMA is so strongly behind this, I believe they were one of the big detractors when the issue of catastrophic illness insurance was a hot topic in the late 70s early 80s. (kind of a similar concept) Maybe this time around with the collective support of so many there will be more progress. I seem to remember a lot of concern regarding decreased general quality and socialized medicine last time I got involved in looking at this to any extent.
    Gardengal, you may find this interesting:

    "1940's
    Truman's plan is denounced by the American Medical Association (AMA) , and is called a Communist plot by a House subcommittee."

    http://www.pbs.org/healthcarecrisis/history.htm

    Everyone read...it's an easy to read timeline from PBS of the developing insurance crisis in healthcare from 1900 - today.
  6. by   sixes
    Iwas shocked to read AMA is behind this also. All our papers etc. state otherwise.
    I would see why they wouldn't support it. Illness is big business, with big dollars. Everything I have read lead me to believe that most health care is privatized.
    I wish I was more educated in these matters
  7. by   CountrifiedRN
    Signed and emailed to my friends!
  8. by   sanakruz
    Kids-
    I work with mentally ill clients and have accessed indigent pt. programs. Each manufacturer is different and there are different hops to jump through. Long waits also.
    It's easy for ill and /or low functioning people to get discouraged and give up in the middle of the process. You are right these folks need advocates- Thast would be WE NURSES.
    Go to nursingdrugguide.com There is a list of drug companies. With some perusal you can find the product you are looking for.If anybody wants some tips send me a pm- I ve got some experience with this
    Fight the good fight.
  9. by   Gardengal
    Sally-
    I found the timeline for the healthcare crisis fascinating. I think one of the interesting pieces is the effect of international war on the issues. I hope that the issues with Iraq are settled rapidly to allow attention to be continued on this important issue.
    Julie
  10. by   kids
    Originally posted by sanakruz
    Kids-
    I work with mentally ill clients and have accessed indigent pt. programs. Each manufacturer is different and there are different hops to jump through. Long waits also.
    It's easy for ill and /or low functioning people to get discouraged and give up in the middle of the process. You are right these folks need advocates- Thast would be WE NURSES.
    Go to nursingdrugguide.com There is a list of drug companies. With some perusal you can find the product you are looking for.If anybody wants some tips send me a pm- I ve got some experience with this
    Fight the good fight.
    The same information is available at www.needymeds.com and links many of the drug companies sites.

    (The information I included in my post is specific to the med & manufacturer in the post)

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