Fall 1998 ~ Newsletter
Cystic Fibrosis and Lung Transplants
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Important Medicaid Issues
by Staci Thrasher, LGSW
1. Many of you may have received information from Medicaid about the new Patient First Program. Patient First is a statewide attempt to provide managed primary care for all patients that are insured by Medicaid. All counties should be under this program by November 1, 1998. Medicaid will assign you a Primary Medical Provider (PMP) which will be a doctor in your county. In order to see your pulmonologist, or any other specialty doctor, you must have a referral from your PMP. It is recommended that when you are assigned a PMP you make an appointment with that person as soon as possible to establish a relationship. It will also be important to inform your PMP that you have a child with CF (or that you are an adult with CF) and that you or your child will need to be seen by the pulmonologist at least four times each year, if not more. If you have questions about Patient First, please call 1-800-362-1504.2. Medicaid has a limited number of pharmacists that are able to dispense only 200 enzymes at one time. As you know, this would only last a patient with CF about one to two weeks. In order to obtain more than 200 enzymes at one time, your pharmacist must call the Alabama Quality Assurance Foundation at 1-888-633-2243 to obtain an override number. This override number will need to be renewed every six months. You may need to educate your pharmacist about this process. Also, your pharmacist may recommend you get generic enzymes because Medicaid will not cover brand name enzymes. Generic enzymes, however, are not equivalent to brand name enzymes and should not be taken by patients with CF. The staff at Children's Hospital will begin writing "no generics" on your prescriptions so that the brand name enzymes will be covered by Medicaid. If we forget to do so, please remind us, because you should never take generic enzymes.