Got Medicaid? Don't Tell the Pharmacist.

You have “state insurance” (Obamacare, Medicaid, whatever). Your physician orders a prescription for buprenorphine. When you go to the pharmacy, the pharmacist contacts your physician to obtain prior authorization for reimbursement. The health plan denies coverage. Fine. You offer to pay directly. The pharmacist says, “Sorry, because you have state insurance, we can’t take your money.” The same thing will happen if you try to use a coupon for free Zubsolv or Bunavail. Furthermore, for Medicaid to cover your buprenorphine you must enroll in a state certified addiction rehab program and undergo drug testing every two weeks. You will only get a two week supply, and even that will expire after 6 months.

I asked several pharmacists, a representative of Orexo (maker of Zubsolv), and a representative of the Washington Board of Pharmacy, and they all confirmed. Apparently pharmacies, “99%” of them, have agreements with payers that prohibit them from providing prescriptions to Medicaid enrollees except when covered, and a federal statute may prohibit pharmacies from honoring coupons or vouchers. The idea is that if you can pay out of pocket for your drugs, you do not need Medicaid.

Welcome to socialized medicine.

I can imagine several ways to preserve your right to buy your prescription:

  • Drop your state insurance.
  • Buy the drug on the street.
  • Go to an out-of-state pharmacy.
  • Lie. Do not tell the pharmacist you have state insurance.
  • Try a mom and pop pharmacy that may not be in bed with the payers.

This policy constitutes a direct attack on private practice medicine, based on fantasy. Buprenorphine should be available over-the-counter. This aspect of the “war on drugs,” will encourage the black market and will result in deaths.

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