Alert: Urge Gov Cuomo to Approve Prescriber Prevails Legislation

This alert comes to NYAIL from the Empire Justice Center. 

Act Now to Ensure that People on Medicaid are able to Access the Medications their Doctors Prescribe!

Right now, Governor Cuomo is considering whether to sign legislation [A.7208 (Gottfried)/S.4893 (Hannon)]  that would strengthen “prescriber prevails” in the Medicaid managed care program. 

In Medicaid managed care, prescriber prevails is supposed to be available for nine types of drugs, including anti-depressants, anti-retrovirals, and anti-rejection, seizure and  epilepsy drugs, along with others.

Because health care providers are familiar  with their patients’ medical histories, they are in the best position to know which medications and combinations of medications are most appropriate, especially for patients with complex needs and multiple conditions.  These providers must make prescribing decisions that take into consideration not only the condition for which a drug is used, but also possible side-effects and interactions with multiple drugs.  Unfortunately, Medicaid managed care plans have been able to prevent doctors’ medical judgment from prevailing by demanding extraordinary proof of a drug’s medical necessity. 

To address this issue, the New York State Legislature passed crucial legislation that clarifies that it is the prescriber’s medical judgment that ultimately determines whether a Medicaid managed care plan must cover a drug in the nine specified classes.  

Right now, this bill is on the Governor’s desk, awaiting his action.  CLICK HERE to urge Governor Cuomo to sign A.7208/S.4893 and fulfill the promise of prescriber prevails made to the poorest and sickest New Yorkers.