Left in Limbo (Page 1 of 4)

Vicky Miller can’t get sick—it’s simply not an option. Miller is already taking eight medications a day and works mostly at night so she can be available to care for her husband, who has uncontrollable seizures, during the day.

With a variety of ailments to treat, including the need to have both knees replaced, her medications aren’t exactly optional. “[I take] two for blood pressure, two for diabetes, a hormone pill, cholesterol pill, arthritis pill, and a sciatic nerve that I take a pain killer for,” Miller says. “Of the eight medications most [are] taken twice a day … luckily I’ve not been sick or anything yet—I’d have to pay for that out of pocket.”

Miller’s health care, including prescription drug coverage, was provided by TennCare until she and 200,000 other Tennesseans were dropped from the rolls in 2005 when Bredesen slashed the state’s budget.

In the time since losing TennCare coverage, Miller has been keeping her fingers crossed that the state’s new prescription assistance program, CoverRx, will kick in before she runs out of pills.

CoverRx helps people get their medications at affordable costs (usually a $3 co-pay). The program was set to begin in January to seamlessly transition those, like Miller, from the safety net program which was designed “to help TennCare disenrollees bridge the gap from TennCare coverage to other health care solutions.” The safety net covered cancer treatments and pharmacy needs according to the Web site. The program was supposed to end in June 2006 but continued through December.

CoverRx has yet to get off the ground, rendering the transition process moot and causing some to juggle their medications, deciding which are the most important as the program sets a cap at five prescriptions a month.

“I quit taking an antidepressant when I got dropped from TennCare, it was pretty expensive,” Miller says. “I was lucky, [my prescriptions] got refilled for three months at the end of December.”

Even those who were able to remain on TennCare are experiencing problems with their coverage and the current state of that program. Among them is Shirley Stooksbury, 50,  who lives in North Knoxville and enjoys doing needlepoint, walking her Chihuahua-terrier, Baby, and spending time at the Time Warp Tea Room on Central Avenue.

Troubled by migraines, bulging disks and an assortment of other health issues, Stooksbury has seven prescriptions filled a month and as an epileptic, was allowed to remain on the TennCare roster.

But she still struggles with financing trips to the emergency room and maintaining her necessary monthly medicines, which are capped at five.

“It’d cost about $1,000 if I had no help [from TennCare],” Stooksbury says of her monthly prescriptions. “I’ve been on TennCare since it started ... I’ve seen a lot of changes. You used to be able to get as many prescriptions as you needed.”

Stooksbury had to go to the emergency room in mid-February after bruising her tailbone and was prescribed two more drugs that she is now required to pay for. “The ER gave me a prescription for a muscle relaxer/painkiller, and [another] one for nausea I’ll have to pay for,” she says. “We are limited by the coverage we have.”

In the past, when her five-prescription limit had been used up and she still needed other medications, she occasionally was reimbursed by her insurance company for her out-of-pocket expenses. “If you use [the prescriptions] up, you’ve got to borrow money and hope the insurance will reimburse you,” Stooksbury says. “For that, you have to file an appeal and wait to see if they’ll reimburse you. It takes 90 days, but in between time they can say ‘nope, not going to pay you back’,” she says.

Similar to Miller, Stooksbury has been forced to become selective about her health services. “It’s hard on people to survive, juggling prescriptions and [deciding] which you need more,” she says. “Sometimes I’ve needed to go to the emergency room and haven’t gone because I didn’t want to borrow money [for more medications].”