Saturday, August 29, 2009

"How's Clare?" Why this work is important.

The U-Haul is coming on Tuesday, and my house is a mess, and the news is all about Health Reform and the Ted Kennedy. Then there is work: Thursday was frustrating. A 13 year old patient of ours had his Daytrana denied by MassHealth. Daytrana is a patch form of Ritalin, one that is quite expensive, and MassHealth rightfully wants us to us it after we have tried other things first. This kid had tried Methylphenidate and Concerta, without much success; Daytrana worked for the last 1.5 years and, as best I can tell, was paid for by MassHealth without a problem. Suddenly, it's a problem. Apparently, there is a written, but not publicly available policy that says that you have to have failed 3 forms of long acting stimulant before you can get Daytrana.

The family is one of the "working poor", with MassHealth as a supplement to private insurance. Their private insurance would pay 50% of the cost of the medication, leaving them with a $179/month out of pocket to stay on the medication. It had been paid for over the past 1.5 years out of their "spend down", which has something to do with their being employed. But $179 per month? They can't afford it. So, on the day before the kid starts 8th grade, I have to switch a marginal student off of the medication that works to a new medication that may not work to "try it out"- if he fails Adderall and Focalin, THEN we can get him back on the medicine that works.

The family sighed, and agreed to the change, but I was frustrated: if we had known of the problem in June, we could have done the required "trials" over the summer and not disrupted school. The needs of the system were served, but it is hardly personal. And mental illness is nothing if not personal.

In pondering the meaning of this incident, I came across this about the Senator in the Globe, and thought is appropriate to quote here at length. Although the Wellstone-Domenici bill was Patrick Kennedy's baby, the Senator's fingerprints were all over it. This is from an article by Kevin Cullen, that was in the Globe:

In the end, that's what the work is all about- building a system so that when you ask people "How's Clare?", they have something good to say about it. Connecting the policy to the personal is hard; Kennedy was the master at it, and we need to get better at it.

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