Medical Society of the State of New York Testifies on New Medicaid Drug Formulary

WESTBURY, NY (12/19/2011)(readMedia)-- Dr. Neil Nepola, a family physician from Staten Island, and President of the New York State Academy of Family Physicians testified on behalf of the Medical Society of the State of New York (MSSNY), on the impact of the Medicaid Managed Care Prescription Drug carve-in on State Medicaid enrollees.

The Medical Society has long advocated for protection of the physician's clinical decision making authority and the patient's unfettered right to access the medication or treatment prescribed by their physician. This is why the Medical Society strongly supported efforts in the past to establish and continue the "provider prevails" language as it pertained to the preferred drug program (PDP) and clinical drug program (CDRP). Central to the Medical Society's consideration of these programs was its position that the PDP & CDRP procedures and rules should not interfere with the ability of a physician to assure that his or her patient has the most appropriate medication. The Medical Society urged the Committee for its support for applying a "provider prevails" policy to prior authorization administered by Medicaid managed care plans for prescribed medical services and pharmaceuticals.

As part of his testimony, Dr. Nepola drew the Committee's attention toward the results of a survey of over 650 physicians conducted by MSSNY between December 1 and December 8 which clearly demonstrate the significant concerns of physicians regarding prior authorization for medications. Many of these physicians treat a large number of Medicaid patients in their practice.

• 96% percent of responding physicians believe that the current PA processes for medications present a burden to physicians and their office staff.

• 65% of these indicated that they or their staff spent more than fifteen minutes to receive PA from a Medicaid managed care plan for a prescription needed for their patients.

• 87% of respondents indicated that the Medicaid managed care plan either occasionally denied or frequently denied their request for PA for a prescription for a patient.

• 47% of physicians appealed the plan's denial of their PA request.

• Importantly, 72% of physicians who responded to the survey stated that at no time during the PA or appeal process were they afforded an opportunity to speak with a physician or pharmacist concerning the appropriateness of their prescription for their patient.

• Overall, 74% of respondents believe that the PA process is more difficult than what existed prior to October 1

• 75% find it to be difficult to access information regarding the Medicaid managed care plan formularies or step therapy rules.

• An overwhelming 94% of respondents believe that the lack of a single state-wide formulary for all Medicaid patients increases the burden on them and their office staff.

• Some of the most frequently cited Medicaid managed care plans include Fidelis, Blue Cross/Blue Shield, HealthFirst, HIP And MVP.

In his testimony on behalf of MSSNY, Dr. Nepola said, "Physicians are subject to an absurd number of requirements imposed by managed care plans and health insurers which force them to take more and more time away from their patients but which in many cases provide no commensurate benefit to the problem. This is extremely costly to the provider and very often diminishes rather than enhances care, quality and access. As government seeks to shift risk downward to the health plans, we are concerned that already burdensome prior authorization processes will become more and more intrusive upon the physician. Already, physicians feel that the medication approval processes in New York cost them unnecessary time and money as they seek to assure that their patients have access to the medications they prescribe. As we move more and more of the Medicaid population into Medicaid managed care, this problem will worsen unless you take action to establish appropriate protections for physicians and their patients. Increasing ancillary practice burdens on physicians will not and cannot save money in the long term. Additional time consuming requirements take large amounts of time and time is an expensive commodity."

To read Dr. Nepola's full testimony, go online to the Medical Society of the State of New York's website at www.mssny.org

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