The Medical Society of the County of Albany

We need your help! Please voice your support for 4 new pieces of legislation that allows doctors and patients to have the final say on patients’ drug regimens and doctors to have one standardized prior-authorization form.

Please call your local Assembly and Senate members and let them know that Medicaid patients continue to struggle with access to prescription drugs as prescribed by health care providers, and doctors and patients suffer when physicians have a number of onerous prior-authorization forms that take time away from treating patients.

Specifically, ask your legislators to speak with their leadership about coming to an agreement and passing these bills (A.10248, A.10249, S.7384 and S.7325) before the legislature adjourns on June 21. You can access the bill text here.

To find your local Assembly and Senate representatives, go here.

Please continue reading for background information and additional details on these crucial bills. As always, thank you for your support!
The tremendous effort that advocacy groups put forth during the budget process to restore prescription drug patient protections in Medicaid is paying off.  The final budget did include the restoration of prescriber prevails for atypical antipsychotics – a move which recognized that access was impaired for some Medicaid recipients.  The Assembly and Senate are continuing the drive, through newly introduced bills, toward ensuring that prescribers will have the final say on prescription drug regimens across all drug classes.

Both houses have also introduced new legislation to create a standard prior authorization process across health plans.  A standardized form is intended to relieve overburdened health care providers of navigating through 21 different Medicaid prior authorization processes.  A uniform process will also enhance patient access by removing a barrier to prescribing practices.

There are differences between the Assembly and Senate approach to both issues.  The Senate simply calls for a Department of Health-approved uniform prior authorization form and allows for prescriber prevails across all drug classes in Medicaid.  The Assembly’s standardized prior authorization bill applies to Medicaid and commercial health plans, and requires input from the Superintendent of Financial Services.  While all plans must accept the standard form, prescriber use is optional unless mandated by an insurer.  The Assembly also sets time frames for drug approval.  Failure to do so results in automatic approval.

The Assembly’s prescriber prevails proposal restores prescriber prevails to all drug classes and restores the prior approval carve-out for atypical antipsychotics, anti-retroviral and anti-rejection drugs and for other drug classes used to treat mental illness and HIV/AIDS, upon approval of the Department of Health.  Prior authorization requests must be addressed within 24 hours with limited exception.  Additions to the Preferred Drug List must consider patient safety, efficacy and outcomes.  Cost effectiveness can be a consideration, albeit secondary.  Lastly, the Assembly proposal requires the development of performance standards to help ensure timely responses to patients.

Both the Assembly and Senate proposals are effective approaches to resolving prescription drug access problems for Medicaid recipients.  Although outside of the conventional budget process, it is possible that with strong advocacy, these bills can become end of session priorities for both houses.  Ultimately, there will have to be agreement on a unified approach in order to send a bill to the Governor.  Agreement will require flexibility from advocates and negotiators in crafting a final product.

It is important to continue the momentum gained during the budget season.  Again, we strongly urge patient advocacy groups to voice support of these bills with your local Assembly and Senate members.  Let them know that Medicaid patients continue to struggle with access to prescription drugs as prescribed by health care providers, and doctors and patients suffer when physicians have a number of onerous prior-authorization forms. Specifically, ask your legislators to speak with their leadership about passing these bills before the legislature adjourns on June 21.

Sincerely,
Jaime Venditti
State Coordinator
New York Health Works
jaimevenditti@gmail.com