Preserving Patient Protections

In 2014, the Executive Budget proposed the elimination of prescriber prevails in Medicaid Managed Care. Prescriber prevails means that doctors have the final authority over medication decisions instead of the government and Medicaid Managed Care insurers. Last year, advocates around the state successfully worked to influence a budget that would protect prescriber prevails in Managed Care for nine drug classes.

This year, we face a similar battle as the Executive Budget proposes the elimination of prescriber prevails again, except in Medicaid Fee for Service this time. Preserving the right of the doctor and patient to choose the most effective medication for that patient’s treatment is critical to providing individualized care.

It is also important to expand prescriber prevails to all therapeutic classes in Medicaid Managed Care. We believe all patients are deserving of equal care and limiting prescriber prevails to nine drug classes prevents patients from getting all the medicines they need. Each patient needs specific medication regimens to treat their illness effectively. Changing even one medication could negatively impact a patient’s health. We should not be making spending cuts on the back of those who are financially the most vulnerable.

Recently, Governor Cuomo released his 30-day budget amendments, which linked prescriber prevails to ethics reform. This action forces lawmakers to adopt Governor Cuomo’s policies or else risk a late budget. Paul Gileno, president of the U.S. Pain Foundation told the Times Union, “Linking the health of New Yorkers to a budget battle is appalling.” Access to quality health care should be a fundamental right of all patients and should not be used in political matters.

Patient advocates all around New York find this action to be unsettling. The executive director of the National Alliance on Mental Illness of New York State, Wendy Burch, explained to the Democrat & Chronicle, “Finding the correct medication regimen for each individual patient is a long and difficult process. The elimination of prescriber prevails could force some patients to switch the medications they found to be most effective after a long period of trial and error.”

Prescriber prevails has a significant impact on patients receiving the medications they need, especially those living with cancer, lupus, and mental illness. Without it, patients who benefit from Medicaid could be switched off of their current medications to cheaper ones. Not all medications work for all patients. Changing a patient’s medication after its effectiveness has already been proven is dangerous and could put the patient’s health at risk.

To find out more about prescriber prevails and what you can do to help protect patients across New York State, click here.


Jaime Venditti, State Coordinator, New York Health Works