This story is about Grace (name changed to protect privacy), a student of color from an economically disadvantaged background who is attending the university where I work as a “college Doctor” on scholarship. She gave me permission to share her story.
Grace’s counselor reached out for my assistance because Grace was struggling academically and emotionally. She had stopped taking her ADHD medication because she couldn’t afford more than $300/month for that medication. She told her counselor that back home she paid a $10 copayment for her monthly ADHD Medicine and another $10 for her anti-depressant. Her legal guardian had been paying the $20/month but was unable to keep up with the costs and time involved in mailing her prescription to her (plus, the U.S. Postmaster told her it was against the law to mail controlled substances via the U.S. Mail).
What I discovered is that Grace could not fill her PCP’s prescriptions unless she went to her chosen in-state pharmacy. Her only recourse would be for her to take a trip home every 3-4 weeks, which was not logistically possible for her (and would cost her more than $300/month). We also called the New York Walmart pharmacist who told me that most students with out-of-state Medicaid plans have ZERO coverage outside of their home state.
As Grace’s story depicts, having health insurance does not equate to affordable care. Her state (and apparently many other states) have made the assumption that if you are poor, qualify for Medicaid and have a chronic health condition, you will not leave the state. One health insurance representative told me that she should think about dropping her in-state Medicaid coverage, and “since she was living in N.Y.” she could apply for NYS Medical Assistance, but there is a more than 3-month wait to get in to see a Medicaid-accepting prescriber in New York who will write for controlled substances. By the time she got through the onerous paperwork, it would be summer and time for her to go back to her home state where her NYS Managed Medicaid plan would not work.
Grace has overcome so much but now must worry about whether she will ever be able to graduate.
We need legislation to break down barriers to care, and the solution (in my opinion) is not to add more layers of rules and regulations. One thing that could ameliorate our current situation is to insist on price transparency at all levels, and to request our national and state legislators to repeal Safe Harbor protection for the Pharmacy Benefit Managers who control all of the prices of drugs in our country. Why does the same medication cost $10 for a 30-day supply in one pharmacy but $300 at another pharmacy? Who is collecting the “kickbacks” and “rebates” and BENEFITING from this pricing? It is not our Patients and it is certainly not Physicians.
We need to advocate for widespread health care reform that would allow Patients from ALL socio-economic classes to utilize health savings accounts. Patients should be able to spend their health care dollars across state lines, and should be able to shop for the best prices.
Make no mistake, our oath to “Do No Harm” should not discriminate.
Dr. Marlene J. Wüst-Smith, M.D., F.A.A.P.
Contributing Editor, Hispanic Outlook on Education. Founding Editor, Physician Outlook
