I try to work within my patient's means as much as possible. If they have crappy (or no) insurance, I try to use the cheapest generic medication possible.
Dr. Cortex, however, uses a lot of brand-new, pricey Wonderdrugs, mainly because he has samples to give out. The problem here is that he also sees A LOT of Medicaid-subplan indigent patients, and once the patient runs out of samples there is NO FREAKING WAY the plan will pay for the prescription.
Normally, this is a problem between he and his patients. Except when he's out of town. Like now.
So Mr. Ictal runs out of expensive Wonderdrug samples for his epilepsy. Dr. Cortex's nurse calls in a script to Local Pharmacy. Local Pharmacy finds out Wonderdrug isn't covered by his Medicaid plan, and tells Mr. Ictal it'll be $400.
So Mr. Ictal calls Dr. Cortex's office. And his staff closed the office to take a 4-day New Year's weekend (which they weren't supposed to, but figured the boss was in Brazil, so who cares?). And so the answering service routes him to me (my office is closed for the 4-day weekend, too).
Wonderdrug won't be covered without a doctor begging, pleading, and filling out a 30 page form. I call the Medicaid subplan to at least beg. But I'm not contracted with that subplan myself, so they won't even talk to me.
The pharmacy (understandably) can't afford to take the loss on a $400/month pill that they know won't get reimbursed. And Mr. Ictal can't afford this at all. And he has 1 sample pill left, and it's pretty damn dangerous for epilepsy patients to stop their meds cold turkey. And he has no idea what he's taken in the past. And I really hate to change meds on a patient I know nothing about. And his chart is locked up in Dr. Cortex's office until next week.
I feel bad for Mr. Ictal. This insanity (mostly) isn't his fault.
What did I do?
Fortunately, I live close to my (closed) office. So I drove down there this morning to meet Mr. Cortex, and gave him enough samples of Wonderdrug so he won't run out before Dr. Cortex can get back and decide what to do. But this is me (and at least I had samples). In all honesty, most other docs wouldn't care, and say they can't help him. Or would tell him to put the pills on a credit card. Or say it's the pharmacy's issue and to call them. Or to go to an ER (I have no idea why he should go to ER for this, but it's amazing how many docs send patients there for stupid shit like this).
The bottom line here is that you should try to work within your patients' means as best you can. It prevents crap like this from happening, and your call partners will be grateful.