SUB-COMMITTEE CLOSES DOWN: After a weekend filled with negotiations
between the Assembly and Senate regarding issues related to the
health and general government/local assistance, the sub-committee
on health met on Sunday evening at 6:00 to finalize the issues
remaining at the table, and both committees reported to the General
Conference Committee ('mothership') at 7:30 later in the evening.
With the exception of issues related to the future conversion
of public health insurance plans to private entities and how to
create a new state Medicaid Inspector General's office to address
fraud in the Medicaid system, the health sub-committee came to
an agreement on the remainder of the issues at their table. In
total, the additions agreed to between the Assembly and Senate
amount to more than $800 M in additional spending above the Governor's
to the issues we have been following, the Health sub-committee
agreed to reject the Governor's proposal to both: 1) eliminate
the "physician prevailing" language from the Medicaid
Preferred Drug List, enacted last year, and 2) include cost
as a factor in determining which drugs would be placed on the
Medicaid program's Preferred Drug List. These restorations
were a major priority to MHANYS and many of our colleagues in
mental health advocacy and represent a very positive development
in the preservation of access to medically necessary medications
for Medicaid recipients.
other major issue we were following at the Health table related
to the extension of a Medicaid "wrap around" for dual
eligible individuals who may be experiencing difficulties in accessing
prescription medications via their Medicare Part D plan. The sub-committee
agreed to the "wrap around" coverage from July 1, 2006,
as the Governor's proposal called for, through to January 14,
2007. While we are pleased by this extension, in that it will
provide a safety net for dual eligibles having difficulty accessing
medications under Part D, there is significant concern about how
this will work in relation to revised formularies under Part D
plans. While dual eligibles can change Part D plans on a monthly
basis, there are likely to be significant changes to the formularies
of these plans starting on January 1st of next year, after all
other enrolled individuals will have had an opportunity to switch
plans (which they can only do during an open enrollment period
at the end of each year). Practically, major difficulties could
re-emerge during this time after the first of the year.
on the sub-committee agreed to further examine "the proposal
to eliminate emergency care prior to eligibility confirmation
("Brad H."), which relates to the provision of services
to those leaving prisons and jails.
thank those who contacted their elected representatives on these
issues and to those in the Legislature who fought to ensure they
remained part of the final negotiation.
proposal would limit access to certain medications.
By Candice Choi
The Ithaca Journal, March 27, 2006
— When the state created its “preferred drug list”
for the poor, a provision was included to preserve a doctor's
authority to prescribe medications not on the list whenever he
or she felt it was necessary.
Gov. George Pataki is proposing to repeal that clause. If successful,
advocacy groups say the state's most vulnerable patients won't
have equal access to prescription drugs.
shocked and alarmed that the state is proposing to change this
— it was a carefully negotiated consumer protection. Our
expectation was that this was an essential part of the program,”
said Chuck Bell of the Consumers Union.
“preferred drug list” was adopted by lawmakers to
curb the skyrocketing costs of prescription drugs. To get on the
list, drug companies must pay the state large cash rebates. Medicaid
will only cover drugs on the list.
preferred drug list is already expected to save $200 million in
its first year of operation by excluding expensive drugs that
may have the same benefits as cheaper versions, according to the
state Health Department. Pataki says repealing the “physician
override” would save another $36 million.
ensure patients would get the most appropriate drugs, consumer
groups lobbied heavily for physicians to retain the authority
to prescribe drugs not covered on the list if needed. The legislation
passed, with the provision that doctors would be able to get prior
authorization from the Health Department to prescribe unlisted
unspoken understanding was that doctors would never be denied
authorization to prescribe unlisted medications, doctors and state
officials have said.
relationship between the physician and patient is something you
never want to mess with,” said Bill Ferris, legislative
representative for the AARP. “Certainly the doctor should
always have the final say.”
only backed the legislation because the physician override provided
the balance of power, he said.
to a written statement from Pataki's Division of Budget, the proposal
to repeal the physician override would enact “needed reforms
to control costs” and help combat fraud. Doctors would still
be able to prescribe unlisted drugs if they provided the state
with “an acceptable clinical rationale,” according
to the statement.
list of drugs would be routinely evaluated by an independent pharmacy
and therapeutics committee.
recent years, many states have enacted preferred drug lists to
stabilize spending on prescription drugs.
2002 and 2004, state Medicaid spending on prescription drugs rose
at triple the rate of overall Medicaid spending. In the 2002-2003
fiscal year, Medicaid spending on prescription drugs in the state
was $3.4 billion; that figure rose to $5 billion in the 2004-2005
Medicaid spending last year was $44.5 billion.
the preferred drug list is just now being implemented, there is
no way to tell what problems may surface or how widespread they
may be, Bell said. That's what makes the proposal so outrageous,
in the best position to make decisions for these patients? To
erect more administrative hurdles really doesn't make sense,”
“somebody up in Albany second guessing” those decisions
makes no sense, Bell said.
Rosenthal of the New York Association of Psychiatric Rehabilitation
Services, said taking away the physician override would force
patients to take drugs that may not be medically suited for them.