As many of you know, my son Andrew (13) suffers from anxiety and depression as a result of past trauma (PTSD). Over the years, he has been on various medications for this and for related conditions (such as trouble sleeping). His depression manifests in various ways, and being a teenager has made him even worse in some ways.
Right now he's on a combination of medications -- Effexor for depression and Clonidine for impulse control and to help him sleep. The Clonidine has had the excellent side effect of helping him with some other physical problems he has been dealing with.
Last week I noticed that Andrew was running low on his Effexor. I called the refill request in to the pharmacy. I expected that it would be ready in a day or two... Not right away because the doctor needed to approve the refill request.
A couple of days went by, and Andrew ran out of Effexor. I knew that we had to get more ASAP because he crashes hard when he suddenly goes off of this med. I mean, the depression and anxiety are probably 10x worse than how he was even before he was on meds. We can maybe limp by a day or two but it gets bad after that.
Come Sunday Andrew was out of sorts. He moped around the house, didn't talk to me much. He didn't respond to me when I told him it was lunchtime. At dinnertime he came storming downstairs demanding food. He was angry about not getting lunch. He started screaming at me and pounding on the walls. I sent him upstairs to cool down and he stood in his room and pounded on things up there, crying and screaming. Eventually he came out of his room and downstairs and announced that he was going to go into traffic and kill himself.
I followed him out the door to make sure he didn't do that. I took the phone with me and called the pharmacy to find out what the holdup was. I was told that the pharmacy had been in contact with the insurance company (actually Medi-Cal, state insurance that we have because we are low income and my job does not provide health benefits). The insurance company was requiring prior authorization. But I was welcome to come get meds from the pharmacy, one day's worth for $19. Great.
While I was on the phone, Andrew ran into the street (luckily we don't live on a busy street) and then back again and tried to attack me. I decided he needed to go to the hospital.
I took Andrew to the county emergency psychiatric unit, which is luckily just a few miles away. He was admitted in right away after I did a little bit of paperwork. They assessed him and kept him overnight. He had his meds and came home the next day feeling a lot better, and much more safe at home.
I went down and paid $19 for a day's worth of pills (that's two Effexor XR 75mg capsules!) for today and called the pharmacy today to ask what was up.
You know what they said? The real reason for the delay was that Medi-Cal had decided that Andrew should be on one 150mg capsule instead of two 75mg capsules. This was their reason for delaying the prescription. For which they will have to pay for his overnight hospital stay. I was so angry. Of course Andrew can swallow a slightly bigger capsule. That would have been preferable to, say, him becoming suicidal. But to me it just seems like a stalling tactic. Maybe if we didn't bother with it, we'd go away and they wouldn't have to pay for his medication?
I looked up the medication. I thought... Maybe the bureaucrats down at Medi-Cal were trying to save the taxpayers money. (I had my doubts about this, since when we switched to Medi-Cal they actually insisted we switch from the less expensive generic to the outrageously expensive brand name! What the heck??) So I found out that the 75mg capsules are two for $19. The 150mg are $17 each. So I suppose they are saving themselves a few dollars. Although anyone in healthcare can tell you that Medi-Cal rarely pays more than a tiny percentage of what they are billed. I have some outrageous examples from my son Ricky's past hospital bills. But I will save that for another time.
So to save a few bucks, Medi-Cal delayed Andrew's prescription. And he ended up in the hospital. It may have worked out okay, but what if he had hurt himself or someone else? What then? I am very angry about this. I don't know what can be done but... It seems to me that something needs to change in this state, to the state of the mental health care/general health care systems. Red tape is coming before patients' health and safety. Where did things go wrong? They are so, so wrong.