NYAPRS Note: At our recent Albany Legislative Day, a large number of NYAPRS members stood up when we asked how many individuals had lost access to their medication of choice and need because of the state’s recent transfer of Medicaid meds coverage to Medicaid managed care plans.
Advocacy has been heating up in recent weeks in support of legislative proposals to restore the ‘prescriber prevails’ protections we had for so many years. That’s where doctors get to trump managed care or state restrictions to assure people get a medication they really need and prefer.
The plans have a restricted list of drugs they pay for…but they promised the Health Department they’d allow people on mental health, AIDS, anti-seizure and anti-transplant rejection drugs to stay on their meds of choice…even if they weren’t on their lists (formularies) to assure continuity of good care. But that’s apparently not happening for too many: too many folks are telling us they’ve been pushed off their drugs and too many prescribers are telling us the plans are making it very tough to advocate for them.
Last Friday, the Assembly released its ‘one-house’ budget proposal but without including a restoration of prescriber prevails that many leading Assembly Democrat leaders had backed. Advocates are urging concerned members to call their Assembly member and Speaker Sheldon Silver today to see that it gets included.
NY Dems, Advocates Seek New Drug Policy
By Michael Gormley Associated Press March 11, 2012
Influential black legislative leaders as well as patient advocacy groups targeting mental illness, arthritis, diabetes, AIDs and other chronic diseases and conditions are pushing to get the Cuomo administration to relax a cost-cutting measure that they say forces patients to use inadequate medications.
Their concern is language in regulations aimed at reducing Medicaid costs. They say the language say allows health benefits managers, rather than physicians, to decide on the best medication for some patients. The directive moves prescription service for 3 million Medicaid recipients to managed care, a way to save money over the traditional fee-for-service method.
The directive is part of Gov. Andrew Cuomo’s attempt to cut billions of dollars from the state’s burgeoning Medicaid health care program for the poor, one of the most generous in the nation. The cost is a huge part of the state budget and is growing faster than any other area.
The decision is projected to save state taxpayers $50 million this year and $100 million in the fiscal year beginning April 1. The change sought by the assemblymen and health groups would reduce those savings $25 million to $30 million a year, according to the Cuomo administration.
The state Department of Health also has a process for patients to contest decisions they feel are contrary to their best health interests.
“In a review of several Medicaid Managed Care Plans since the pharmacy program went into effect in October less than half a percent of drug claims are denied after an appeal is made. We have not had any significant level of complaints on this topic,” said Michael Moran, a health department spokesman.
“We understand the need to trim health care costs, but we disapprove of the difficulties that low-income people are experiencing at the pharmacy counter,” stated the letter to Gov. Andrew Cuomo from eight prominent Democratic assemblymen including Keith L.T. Wright of Manhattan, one of the chamber’s most respected members.
They argue a physician and patient, not the lower cost of generic drugs, should guide what medications are prescribed for millions of New Yorkers being treated for mental illness, arthritis, diabetes, AIDs and other chronic diseases.
“The health disparities in our communities are extreme. Overwhelming numbers of our constituents have multiple and serious health problems,” the Democrats stated. “Research shows that there are racial, ethnic and gender differences in response to health care treatments. By applying a one-size-fits-all approach in Medicaid, New York will worsen existing health care disparities. We must do better.”
The Cuomo administration had no immediate comment Friday.
But last week, when shown how a similar Medicaid cost-cutting measure created concern for women receiving contraceptives, the Cuomo administration ordered health care providers to address the needs of patients. The administration said that means companies that want to maintain state contracts must respond to patients even if it means continuing to prescribe higher-cost, name-brand contraceptives.
“The governor’s recent decision to reverse limitations on patient choice regarding contraception for those on Medicaid is an important step in the right direction,” stated a coalition of patient advocacy groups, including a chapter of the Lupus Foundation, the Long Island Breast Cancer Coalition, the Mental Health Association of New York State and the Northeast Kidney Foundation.
“However, many other vulnerable patient populations still need the governor’s help,” the group said in a plea to Cuomo last week. “For example, people with mental illness who finally find a drug that works for them do not want to be told to try another drug, which might fail. The same is true of those undergoing chemotherapy, treatment for HIV/AIDS, or a host of other treatments and therapies.”