Joint Statement By Patient Advocacy Organizations, Medical Professional Organizations and Legislators Regarding Restoration of Prescriber Prevails Protection

Joint Statement By Patient Advocacy Organizations, Medical Professional Organizations and Legislators Regarding Restoration of Prescriber Prevails Protection

We are extremely pleased that state lawmakers and the Governor have restored and expanded prescriber prevails protections in New York.

This is great news for millions of Medicaid patients across the state who wanted their doctors, not heath plan managers, to have the final say on what medications they receive.

Had this policy change not moved forward, these patients would have had their treatment regimens disrupted, and in many cases there would have been adverse health effects.

But thanks to concerned lawmakers in both houses, the patient protection “prescriber prevails” will now apply to 8 important additional classes in Medicaid managed care starting July 1st(for a full detailing of the restored classes, click here) and will continue for the atypical antipsychotic drug class, as well as for all classes in fee-for-service. There is hope that this protection may be expanded to other classes in managed care next year.

We especially want to thank Legislative Mental Health Chairs, Senator David Carlucci and Assemblywoman Aileen Gunther; Health Chairs, Senator Kemp Hannon and Assembly Member Richard Gottfried; and Assemblyman Karim Camara.

The effort to preserve patient protections will continue. Our coalition will be carefully monitoring this and related issues.

Below are additional quotes and messages of support from patient advocates, medical professional organizations and lawmakers:


“During this difficult budget season, the substantial restoration of ‘prescriber prevails’ is a critical healthcare victory for the millions of New Yorkers on Medicaid who are living each and every day with life threatening diseases such as lupus, HIV/ AIDS, diabetes, rheumatoid arthritis, and multiple sclerosis,” Assemblywoman Vanessa L. Gibson (D-Bronx, 77th AD) said. “It promises improved medical care for those facing health challenges, and I am grateful for the commitment and support of so many health advocates and Assembly Speaker Sheldon Silver on this important public policy issue.”

“We thank the Legislature for their strong support for Prescriber Prevails for all drug classes. We are especially pleased to see it restored for atypical antipsychotics and the addition of anti-depressants. Individuals with psychiatric disabilities, in consultation with their doctors, should have the final say in their medication options. This legislation creates a ‘consumer safety net’ to insure that the appropriate choices are being utilized by individuals and their prescribers and not driven by formularies of health plans.”- Glenn Liebman, CEO, Mental Health Association in New York State


“Bravo!  We applaud our legislative champions for listening to the advocacy community and thank them for improving access to vital treatments for millions of our most vulnerable citizens through the Prescriber Prevails restorations.  Kudos to all who joined forces, fought tenaciously, and stood their ground on this significant patient protection that therapeutic decisions should be made by patients and the health care providers who treat them and these determinations should be based on sound clinical considerations, not on cost.”- Kathleen Arntsen, President & CEO, Lupus Foundation of Mid and Northern New York


“We are delighted that our NY Legislators heard the voices of the many patient advocates across the State about the importance of reinstating prescriber prevails in NY’s Medicaid program.  By this reinstatement, our legislators are putting healthcare decisions back where they belong – in the hands of the healthcare team.  We applaud the legislature for this significant move to protect patients across New YorkState.” –Carol LaFleur, Executive Director, Northeast Kidney Foundation


“Family physicians are first and foremost advocates for their patients. Restoration of prescriber prevails restores and reinforces that historic and intimate relationship which patients have come to expect and rely upon with their physicians. We deeply appreciate the leadership of Senators Hannon & Carlucci, and Assembly Members Gottffried, Gunther and Camara in protecting the basic right of patients to have physicians who are empowered to protect their interests in having access to the medications that are most appropriate and most effective for them.”- Vito Grasso, Executive Vice President, NYS Academy of Family Physicians


“Open access to medications is especially crucial for the mentally ill, and is a critical component of successful community-based care.  Restoration of prescriber prevails provisions represents an important victory for our members.  We wish to thank our state’s leaders for recognizing the importance of this issue, and for their support of those struggling with mental illness.”- Don Capone, Executive Director, National Alliance on Mental Illness NYS

“In light of the current nationwide physician shortage, it is likely that many psychiatric patients are using their primary care physicians for treatment-especially in rural areas, where specialists are in short supply. As the representative of 5,000 osteopathic physicians in New York State, many of which practice in rural areas, the New York State Osteopathic Medical Society applauds the restoration of this essential patient protection.”- Anna Lamb, President, New YorkState Osteopathic Medical Society

“Thank you for your commitment to prescriber prevails protection and its focus on patient advocacy, safety and social justice in the management of those entrusted to our professional care”-Maria Elena Piña Fonti RNMA, President, NY Chapter of the National Association of Hispanic Nurses


“Since the beginning of the Medicaid program, MSSNY and its member physicians have advocated to assure Medicaid insured patients can get the care they need.  This includes assuring a wider availability of physicians to provide needed care, and the ability to determine without undue interference what is best to treat or stabilize the patients’ particular condition.  This relationship also requires that the patient and physician be able to decide the most appropriate medication.  We praise the efforts of the many legislators who advocated to assure that this year’s State Budget restored this important patient protection to several categories of medications in the Medicaid Managed Care program.- Robert Hughes, MD, President, Medical Society of the State of NY

“We are pleased that our leadership in the state of New York has agreed on allowing patients to get the treatment that is most appropriate for them according to their providers.  Reinstating this provision will go a long way to improving the health outcomes of our most vulnerable communities in our state.”- John Hellman, Director of Advocacy, Latino Commission on AID