NYS Medicaid Changes: Do You Know if Your Prescription Might Not Be Available to You on October 1st?

With major changes coming for millions of New Yorkers -- GHLF offers advice and tips to residents in the transition

NEW YORK, Sept. 27, 2011 /PRNewswire-USNewswire/ -- In less than a week the rules will change for millions of New York residents on Medicaid who rely on prescription drugs to treat life-threatening and debilitating diseases, and many of them may be unprepared for the transition.

As a part of Governor Andrew Cuomo's Medicaid Redesign plan, prescription benefits through Medicaid become part of the private managed care system on October 1. For nearly 3 million New York residents, that means the managed care plans have the ability to restrict the medications offered for residents enrolled in those plans and many medications will no longer be available to them.  

For example, on October 1 Medicaid beneficiaries who suffer from fibromyalgia, an often debilitating form of arthritis, and are enrolled in FidelisCare, will no longer have unrestricted access to medications like Cymbalta, Lyrica or Savella. Other health care plans are taking similarly restrictive approaches in what will be available for patients on October 1.

Global Healthy Living Foundation and other patient advocacy organizations are concerned that due to a lack of outreach by the state, and the Medicaid's transition to the private sector, many patients may not be prepared to handle the new system.  

GHLF President Seth Ginsberg said, "The change that is about to occur for millions of New Yorkers is unprecedented.  Without proper information and planning, residents on Medicaid could face major hurdles in receiving medications that keep them working and healthy.  Beyond the inconveniences and loss of income this could cause, there is a risk of medical setbacks and consequences for this vulnerable population."

Global Healthy Living Foundation is offering these tips to help residents prepare to navigate the process of managing their prescriptions:

Check now with your managed care plan:
Many of the 21 managed care plans that will administer medications to residents have posted updated information on their websites about what medications will be available.  Log in now to check if the medication you're currently taking will be covered after October 1st.  Many plans are sending letters, too, so carefully read anything you get from your managed care company.

Talk with your doctor:
It is imperative that patients and doctors have conversations before October 1st about any change that could occur to the medications a patient is currently taking.  If your medication is switched, your doctor needs to know to ensure there are no medical consequences or negative outcomes that could affect your health.

Don't be afraid to ask questions:
Call the managed care company assigned to you, call the New York State Department of Health at 800-541-2831.  If you live in New York City, or your city has 311 service, call it, too.

Check with local support groups:
Many patient advocacy organizations such as the Patient Advocate Foundation are working with people on Medicaid to help with this transition. They can be reached at 800-532-5274 or at www.patientadvocate.org. Neighborhood community centers, hospitals and clinics can also help. Check with these organizations in your neighborhood to see what resources are available to you.

Tell GHLF when you are denied drugs or services:
One way to fix problems that will occur during this transition is to speak up. The Global Healthy Living Foundation has a privacy-enhanced website where people can list the drugs or services they were denied. GHLF will use this data to measure the success of the program and negotiate with the state and private insurers for better care. It is important to go to www.ghlf.org and click on "I've been denied" on the home page.

"New York State Medicaid is in transition, and it is not necessarily good for patients," said Ginsberg.

"It is important that patients continue to work with their healthcare providers and your new managed care company to make sure that serious health conditions are treated, even though it most likely will take extra effort to do this.

"Reach out to your friends, family, community groups and churches, too. They can help make sure you receive the medical care New York State law guarantees."

About the Global Healthy Living Foundation
The Global Healthy Living Foundation is a 501(c)(3) non-profit organization focusing on access to care for patients, caregivers and physicians. We are located at 515 N. Midland Ave, Upper Nyack, NY  10960. www.ghlf.org . Tel: 845-348-0400.

Available Topic Expert: For information on the listed expert, click appropriate link.

Contact: Seth Ginsberg, President, 845-348-0400 or [email protected]

SOURCE Global Healthy Living Foundation