Cuomo Urged to Give Doctors Final Say on Medicaid Prescriptions in Managed Care Plans

by Andrea Sears

ALBANY, N.Y. – Health care advocates are urging Gov. Andrew Cuomo to sign a bill that would give doctors the final say on prescriptions for their patients in Medicaid managed care plans.

Regular Medicaid already has what is called a prescriber prevails provision allowing doctors to choose specific drugs.

But attorney Amy Lowenstein at the Empire Justice Center explains the managed care plans have been denying requests or suggesting cheaper alternatives for nine classes of medication.

“For these types of drugs, it’s really important that access be granted and that it be granted immediately, and not put somebody’s health at risk while they’re waiting to fail on other drugs,” she stresses.

More than 5 million New Yorkers are enrolled in Medicaid managed care plans. The drugs involved include diabetes medications, antidepressants, seizure drugs and anti-retrovirals.

Insurers insist that making the change would increase Medicaid’s prescription drug costs in the state by tens of millions of dollars.

Cuomo’s budget proposal had called for eliminating the prescriber prevails rule for regular Medicaid, but the legislature rejected that.

Lowenstein says once the budget was done, the bill to strengthen the provision for Medicaid managed care passed both the Assembly and Senate with bipartisan support.

“We’re talking about the Republicans and the Democrats coming together and just saying, ‘This is something that’s important – it’s important to our constituents, it’s important to patients and it’s important to us,'” she points out.

Given the governor’s previous views on the prescriber prevails provision in Medicaid, Lowenstein says advocates are concerned that he may veto the bill.

PHOTO: Advocates of legislation to give doctors more say over what they can prescribe for Medicaid patients say it would strengthen the Medicaid prescription drug plan, to benefit the poorest New Yorkers and those with the greatest medical needs. Photo credit: Bmramon/en.wikipedia.