How Do I Get On Medi-Cal? The Board That Is. That Decides What Drugs Are Covered.

So, I used to be a Medi-Cal expert. Medi-Cal, for those of you in the inferior 49 states, is our name for the medicaid program. Take out the hyphen. We're clever like that here. At any rate, you can't not work in the ghetto and avoid becoming adept in the intricacies of  getting a Medi-Cal claim to go through. Bizzare stuff some of it. My favorite was the requirement that a documented diagnosis of HIV be on the face of any prescription for AIDS meds. Like doctors otherwise would go around giving protease inhibitors to people with the common cold I guess. I also remember that Medi-Cal would only cover Ortho's birth control pills. Send a claim for a generic and you'd get yourself a big fat rejection with an explanation that wouldn't make any sense. That always threw the newbies in our store, who would always say the same thing:

"Why the ^%$! would they pay for the brand name and not the generic?"

Then there would almost always be some sort of joke about kickbacks.

Ha ha ha.

At least, I always thought it was a joke. From the San Francisco Chronicle:

Three California officials who oversee billions of dollars in Medi-Cal prescription drug spending have failed to disclose free flights, hotel rooms and meals paid for by nonprofit groups funded by drugmakers, records and interviews show.
One of those officials, Pilar Williams, accepted free travel even though she has a direct role in negotiating rebates with drugmakers. Williams, the pharmacy division chief at the Department of Health Care Services, also helped decide which drugs were among the $8.5 billion worth of medications the state dispensed to low-income patients in the past three years.
The three officials' travel was paid for by several nonprofit business groups that exist for the sole purpose of funding conferences and meetings, according to a chairman of one of the groups. The business groups raise money by charging registration fees up to $2,000 per person to drug company representatives and other executives who do business with Medicaid programs.
Since 2005, those corporate executives contributed about $1.8 million to the business groups to pay for conventions - including the costs of travel, lodging and entertainment for the state Medicaid pharmacy directors, California Watch has found.


Actually, there is a joke in this story. Here it is:

Norman Williams said officials will report future trips to conventions...He described the conferences as great idea-sharing forums.
Pharmaceutical executives "do not try to influence (our) decisions in any way," he said. "And we would not attend those conferences if that were the case."


"As a corporate executive I couldn't agree more" Pfizer Chairman and CEO Jeffrey B. Kindler didn't say. "Every time I bring up the prospect of using a large sum of company money to get absolutely nothing in return our stockholders applaud and say nice things about me. They realize, after all, that the foundation of American capitalism is that the corporation has a duty to spend money that would otherwise be added to our quarterly profits, for no reason other than to make the world a better place. For a few people who may have the power to give us more business. Not that we've noticed whether they do or not."

"I thought we put these ethical type issues behind us when we stopped giving out the free pens." He didn't add, with a puzzled look on his face.

"Jesus you are one cynical bastard Drugmonkey" I can hear you saying. "Can't you at least entertain the possibility that these people are professionals who went to these meetings to enhance their on the job performance?"

Sure I can. Oh, speaking of entertainment:

The agenda showed that officials from at least 22 states attended sessions. But it also showed there was ample free time. On one day, sessions ended by 11 a.m. Networking and entertainment was scheduled until midnight at the resort, which featured an indoor theme park and water park.

Before 11 a.m the meetings probably stressed things like how important it was to document that AIDS meds weren't being used to treat the sniffles. I have a feeling the reason those Ortho products were covered... might have something to do with what went on later that afternoon.

I wish real life would stop stealing my jokes.

Thanks to the alert reader who tipped me to the story.

Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/28/MN4A1C80TR.DTL#ixzz0hZBuwwBR
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How Do I Get On Medi-Cal? The Board That Is. That Decides What Drugs Are Covered.
How Do I Get On Medi-Cal? The Board That Is. That Decides What Drugs Are Covered.
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