What I learned about Medicaid while working for CVS/Pharmacy

Let me share with you what I learned about Medicaid while working at CVS/Pharmacy.  First a little background, I spent over eight years at CVS/Pharmacy.  During my time at CVS, I spent a couple of years in an underprivileged area, where Medicaid is the predominate form of insurance (if we can call it insurance).  This was a life changing experience for me in several ways.  First, I realized I definitely did not want to become a retail pharmacist.  Second, I grew to despise all “poor” welfare recipients.  Now at first, this may make me sound like an insensitive jerk, but let me explain.  These so called “poor” people that frequented my store brought with them their unrivaled feeling of entitlement.  They truly believed everything was to be hand fed to them on their schedule and according to their needs.  Honestly, I cannot say this is entirely their fault.  Nonetheless when I say they felt entitled, I do not just mean to free drugs.  These people felt entitled to have their scripts filled in thirty seconds.

Medicaid customers would show up without their card having never been to a CVS before and expect me to have some magical way of handing them a free prescription in a matter of seconds.  They were not responsible for keeping track of their own Medicaid information and if you ask them for it, they reply with “isn’t there a number you can call?”  I think they truly believe that I had some kind of insurance white pages and I just wasn’t willing to search for their name.

What are worse are the things that Medicaid would cover.  For instance, Georgia Medicaid covers a drug called Accutane.  Accutane is the last measure of treatment for acne.  Yes acne!!  The cash price of this drug is over $500/month.  Most real insurances charge a co-pay of at least $50.  Yet Medicaid customers get it for "free".  This is a crime in my opinion.  Another example, Methergine is a drug which is almost always used after an abortion in which case it is taken alongside doxycycline and ibuprofen.  I used to fill these medications at least once a week.  For those of us who don't want to fund abortion this is a problem.  I can't speak as to who paid for the actual abortion, but I know we are funding the pills after the abortion.

What can be done?  Here is my three-fold solution:

1. First we need to cut down what drugs are covered for Medicaid patients, $500/month for an acne medication that is unnecessary and ridiculous.  Acne is a part of life, and most middle class kids deal with it because their parents will not be paying a $50 co-pay just for acne.  Methergine would also fall in this category of drugs that should never be covered at the taxpayers’ expense.
2. We must instigate real co-pays for Medicaid customers.  Believe me when I tell you most of these customers had enough money to pay regular co-pays like the rest of us (see point 3).  The argument made for Medicaid was that poor people cannot afford insurance. Fine give them Medicaid, call it insurance, and let them have all the co-pays that come along with real insurance.  This will help keep them away from the doctor for every sniffle they get.  While I struggled through college on Mac & Cheese, I didn’t visit the doctor unless it was important because I could barely afford the co-pay.
3.  We must cut down the number of people on Medicaid.  We must find a way to prevent Medicaid fraud.  We had two customers which I distinctly remember because their situation was so exaggerated and they visited once a week.  I assure you more like them exist and often stopped by.  Of the two customers I speak, one drove a new blue Hummer H2 and one drove a new black BMW.  Both were on Medicaid.  Now I don't know if they drove these to the Medicaid office when they applied, but they certainly pulled through my drive-thru once a week.  This is insane.  Stricter rules need to be put on the application process for Medicaid.  With as much as our government loves to create new regulations you would think this would an easy reform to pass, but instead they are too busy regulating the “rich” small business owners.

What are your thoughts on my solutions, and what else could be done to reign in this Medicaid money sink?