Diary of a Neighborhood Pharmacist, Entry #14

I don't know if this is a legitimate diary entry or not, but it's a legitimate observation. Now and then, we would have patients come in with large piles of prescriptions – drugs for chronic conditions, asthma and diabetes usually – although there might be still a third condition, such as high blood pressure, as well. In each case, these were Medicaid patients.

Our other patients, private insurance, military or military dependent (the pharmacy serves a navy-coast guard installation), or even cash, might have prescriptions for one condition, but only one. It wasn't a matter of Medicaid fraud or over prescribing, these people really had multiple problems. Usually they were badly overweight, which predisposes to the conditions they were being treated for.

And what came to mind was that the common factor was poverty.

Medical care is important, and Medicaid gave them that, but it wasn't enough to assure them a proper diet, or good air (we do tend to put garbage dumps, generating plants, and other sources of pollution in the neighborhoods of those with the least political influence). Working in Nassau County [on Long Island], I've filled Medicaid prescriptions often enough, but these were for people in acute poverty – short-term poverty experienced by people who had no assets and had lost their jobs, but could be expected to find jobs soon enough. But in Kings County [Brooklyn], I was dealing with chronic poverty – a cycle of poverty, generation after generation.

More on this another time …

*   *   *   *   *

The prescription drug plan I'm on has a fixed co-payment, regardless of the price of the drug, but many plans are discount plans. They help, but not nearly enough when the drugs are expensive.

The other day, Gina*, a grandmotherly lady who works here doing stock work, brought me a prescription for herself. "I have insurance," she said, with some pride, as if it were a status symbol. But when I priced it, even with insurance, the prescription was $21.50, and that was more than she had. I wound up paying for her prescription myself.

In California, they had propositions on their ballot that would offer prescription drug discount plans, but what good is a discount when some of the drugs cost thousands of dollars, and I see Medicaid patients who can't manage the $1.00 or even 50¢ co-payments?

*not her real name

See the previous installment, Diary of a Neighborhood Pharmacist, Entry #13, or the next installment, Diary of a Neighborhood Pharmacist, Entry #15.

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