As you may be aware, the 2016-17 final budget was passed on Friday. We had many successes in the budget and you were an instrumental part of this success through phone calls, emails and letters to the NYS legislature. Thank you for all of your hard work and for your dedication to patients!
The following is an update on health items in the final budget that many of you worked on directly and that impact the patients you work with.
Medicaid Prescriber Prevails: Governor Cuomo’s budget included a repeal of Prescriber Prevails in Medicaid Fee for Service and Medicaid Managed Care. This proposal was REJECTED in the final budget. Prescriber prevails was RESTORED in Medicaid Fee-for-Service for all drug classes and Managed Care for nine drug classes. The NYS Senate proposed extending Prescriber Prevails to all classes in Medicaid Managed Care and including language clarifying that the prescriber’s determination is final in Managed Care, but it was not included in the final budget.
Prior Authorization Expansion in the Clinical Drug Review Program (CDRP): This proposal would have allowed the prior authorization of Fee for Service medications in the CDRP before the DURB conducted an evaluation and issued recommendations. This proposal was REJECTED in the final budget.
Prior Authorization of Opioids: This was ACCEPTED in the final budget and MODIFIED to include exceptions for persons in hospice care, persons with cancer, sickle cell anemia or any other condition or diagnosis for which the Department of Health Commissioner decides that prior authorization is not required.
Electronic Prescribing: The final budget includes an exception to the recently implemented e-prescribing law for practitioners who issue not more than 25 prescriptions during a 12-month period.
Medicaid Coverage For Persons Immediately Prior to Release From Incarceration: This Assembly proposal was ACCEPTED in the final budget and provides statutory authority for the state to pursue a federal waiver for Medicaid coverage for high-needs inmates, 30 days prior to release, for transitional services including medical, prescription drug and care coordination in state or local correctional facilities.
Thank you again to all of you that weighed in on these issues and please stay tuned as we continue to fight for better healthcare access for all New Yorkers!