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Budget Cuts

Posted Jun 14 2009 10:13pm
Proton pumps inhibitors such as Prilosec, Nexium, Aciphex, and Protonix have become so commonly used in medicine to say they are given out like candy would be to over state the popularity of candy. Unfortunately these are also expensive medications.

The legislature passed some $42 million in cuts to the state's Medicaid budget this year. Included in the cut backs are no more proton pump inhibitors for patients on state insurance unless a documented ulcer is present, the patient has a zebra of disease called Zollinger -Ellison Disease, or they are willing to surrender their first born child. It was in this context about a month ago a man in his fifties switched from his proton pump inhibitor to ranitidine ( Zantac ).

While this patient was in his fifties he really had the look of a man in his seventies from years of abusing his body with smoking and probably more alcohol than was good for him. He took an ibuprofen like anti-inflammatory medication for his arthritis to try to limit the amount of narcotic pain medication. He did well with this combination until a few weeks after the state declined to cover his medication for his stomach.

Last week he came in to see me as white as lab coat. His hematocrit had dropped to transfusions levels, so I admitted him and tanked him up with four units of blood. When he was scoped, the anti-inflammatory medication had worn a hole in his stomach. He'll recover from this hospitalization and now he'll get his proton pump inhibitor.

Now it would be simple and simplistic to conclude the state's to blame for this stomach ulcer requiring a hospital admission and multiple transfusions. This patient had abused his body for years and now his health was catching up with him. The pharmaceutical industry certainly has not looked to lower the cost of its products. The public expects the latest and greatest medications. Doctors have let themselves be lured into driving up health care costs through prescribing expensive medications when less costly ones will do.

Now if we can only all figure out a solution to this problem we have caused.

The Country Doctor
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