In this week’s summary, you’ll read about an update in the NYS budget regarding Medicaid, latest guidelines for health plans providing services through health exchanges, a new study regarding expanded insurance coverage and the primary care doctor shortage, and more!
NYS Budget/Presciber Prevails
State Senator David Carlucci and mental health advocates joined together this week to call on Governor Cuomo to restore prescriber prevails to the Medicaid pharmacy benefit to ensure that Medicaid recipients have access to appropriate medication. Carlucci and the Mental Health Association of Rockland County argued that doctors are in the best position to determine what medication their patients need— not a health insurance company.
Governor Cuomo released 30-day amendments to his 2013-14 budget yesterday. As expected, the amendments cut $500 million from the state Medicaid program to address the loss of federal Medicaid revenue as a result of required modifications in how the state finances services for people with developmental disabilities. The cuts will include $180 million from accelerating Medicaid Redesign Team initiatives and delaying investments originally proposed in this year’s budget, leveraging $200 million in current-year under spending to generate 2013-14 savings, and $120 million from a 6 percent reduction to OPWDD Medicaid rates for not-for-profit providers.
Affordable Care Act/Health Exchanges
This week the Centers for Medicare and Medicaid Services issued its latest guidance on what benefits must be covered by health plans that sell policies through a state health benefit exchange. Under the Affordable Care Act, insurers must cover 10 broad categories of care, including emergency services, maternity care, hospital and doctors’ services, mental health and substance abuse care and prescription drugs. The final rule retains requirements that insurers offer at least one drug per therapeutic category, or the same number as a state’s benchmark plan, whichever is greater. The final rule also states that insurers must have procedures to allow patients to get “clinically appropriate” prescriptions not on the plan’s list of covered medications. In addition, the new rule will require health insurance plans to cover mental health care and substance abuse treatment in the same way that physical illness is covered (USA Today, Kennedy, 2/20).
The federal government will be running new health insurance marketplaces in half of the states— including the major population centers of Texas, Florida and Pennsylvania. The deadline for states to agree to form partnership exchanges with other states passed last week with many states deciding to allow the federal government to run the new exchanges. The Washington Post writes that the development of exchanges under the Affordable Care Act is turning into a national experiment to see whether the states or the federal government will do a better job of providing coverage to uninsured Americans (2/16).
The New York Times writes that many companies will be able to avoid requirements in the Affordable Care Act by insuring their own employees, rather than signing up with commercial insurers, because Congress did not want to disrupt self-insurance arrangements that were seen as working well for many large employers. Federal and state officials and consumer advocates are worried that companies with relatively young, healthy employees may opt out of the regular health insurance market to avoid the minimum coverage standards in the ACA. Such a move could drive up costs for workers at other companies (Pear, 2/17).
A new study, released this week by Health Affairs, finds that expansion of insurance coverage under the Affordable Care Act (ACA), with an expected increase in demand for primary care physicians, would directly impact some 44 million people who live in areas where the projected increase in demand for primary care providers is greater than 5 percent of current baseline supply. Of those, seven million people live in areas where the demand will exceed supply of primary care providers by more than 10 percent.
The New York Times reports that more drugmakers are helping the World Anti-Doping Agency in creating tests that can help detect the abuse of treatments to improve performance in sports. Two major companies and several smaller firms will share information about their drugs to WADA. Drugmakers have a key part to play in stopping the abuse of new prescription treatments, WADA officials said (Thomas, 2/18).
-Jaime Venditti, 2/22/13