Public participation needed on medicaid drug access
25th June 2012 · 0 Comments
The Louisiana Department of Health and Hospitals is completing a series of public hearings in Baton Rouge and New Orleans next week about the new pharmacy benefit available through the revamped Medicaid managed care plans or Bayou Health.
It is important patient advocates, especially those with chronic illnesses such as mental health, HIV/AIDS, autism, epilepsy, arthritis, cancer and other diseases which require access to medicines, participate in these hearings.
Access to prescribed medicines helps patients remain healthy and independent, and in the long run, independent patients are less costly to health plans than institutionalized ones.
Here are the simple issues we believe DHH needs to do a better job of addressing at these hearings.
• Assure continuity of care for beneficiaries with chronic conditions.
• Require Medicaid drug formularies to be comprehensive—covering prescription drugs in all categories and classes—with additional protections for vulnerable populations. Similar standards apply to Medicare Part D plans.
• Require managed care plans’ formularies to be developed and reviewed by an independent pharmacy and therapeutics committee (P&T). Moreover, the P&T committee must review the formulary management activities, such as prior authorization, step therapy, quantity limitations, generic substitutions, and other drug utilization activities for clinically appropriateness.
• Allow patient choice. All plans and their formularies must be made publicly available to patients, including being posted on the plan website, in a timely manner so that patients can make appropriate healthcare decisions.
• Require that Medicaid managed care formularies are no more restrictive than the coverage provided under Medicaid fee for service.
• Medical management tools (e.g. prior authorization, quantity limits) must be consistent with “best practices.” A plan must provide response within 24 hours of a request for prior authorization or override of other medical management tools.
• Standards for exceptions and appeals must be clear, including expedited review (within 72 hours) for urgent or emergency medical conditions as well as continued benefits during the appeal.
• Review and inclusion of new prescription drugs and other treatments and therapies must be spelled out.
• Quality and access report must be required. Require the state to prepare a report assessing beneficiary access no later than 18 months after the implementation of the managed care expansion to new populations and/or for new items and services. The report should be submitted to the state legislature, be posted on the state Medicaid website, and the agency should provide an opportunity for public comment.
The public can raise these and other issues at the following hearings: Tuesday, June 26 – Greater New Orleans, 6-8 p.m., West Bank City Council, General Government Building, 200 Derbigny St., 6th floor , Gretna, LA 70053 and Wednesday, June 27 -Baton Rouge, 6-8 p.m., Galvez Building – Oliver Pollock Room, 602 N. Fifth Street, Baton Rouge, LA 70806.
– Cheron Brylski
This article was originally published in the June 25, 2012 print edition of The Louisiana Weekly newspaper