Supporters of a bill that would ensure doctors have the final say in prescription disputes with Medicaid managed care plans are urging Gov. Andrew Cuomo to sign the measure into law.
The measure, one of about 700 bills passed by the state lawmakers this year and under review by counsel, has not reached the governor’s desk, according to Cuomo spokesman Rich Azzopardi.
Given the administration’s past stance on language in the bill, however, supporters are concerned over the chance of a veto.
“The Health Department opposed this language when it was raised during budget discussions,” said Assembly Health Committee Chairman Richard Gottfried, D-Manhattan, a bill sponsor.
The bill revises the wording governing disputes over prescriptions for nine classes of drugs offered through Medicaid managed care plans to be the same as it is for Medicaid fee-for-service plans.
It makes explicit that “the prescriber’s determination shall be final.”
Medicaid managed care plans, which cover over 5 million New Yorkers, have been interpreting current wording in the law to mean the plan must agree with the doctor’s demonstration that his judgment is correct, according to Gottfried. The plans are increasingly using the language to deny patients access to certain drugs, according to a statement from 30 organizations representing patients, medical providers and the pharmaceutical industry.
“We’re talking tens of millions of dollars” in this fiscal year, said Health Plan Association spokeswoman Leslie Moran.
The state Health Department did not respond to an inquiry seeking comment on the proposal.
Earlier this year, the governor’s budget proposal had called for removal of the so-called “prescriber prevails” provision from Medicaid fee-for-service plans.
The Health Department estimated its elimination would save $4.1 million in this year’s budget and $5.5 million in the year beginning April 2016.
Lawmakers in both houses rejected the proposal, and proposed strengthening the language for Medicaid managed care instead.
