In October of 2011 a major shift in the New York State Medicaid policy occurred, giving managed care organizations the right to decide upon the “best” medications for patients. Removing this authority from prescribers led to confusion, lack of uniformity in coverage, denial of critical medications for patients, and compromised care for many. As is typical of many policies, cost effectiveness was at the root of this change. Clearly, however, negating the expertise of physicians, superseding the doctor/patient relationship, and denying patients medications deemed necessary for their wellness had quite a cost…a human cost.
In reality, it can take time for patients to stabilize on medications. Psychotropic medication regimens in particular need to be individualized, closely monitored, and adapted to changing patient needs. It is only with this structure of care that individuals will achieve and maintain the recovery they so deserve. Additionally, the financial cost of destabilization, or chronic difficulties as a result of less than optimal medications, becomes exorbitant.
In 2012, prescriber prevails was restored for atypical antipsychotic medications for people affected by mental illness. This year, however, Governor Cuomo proposes repealing this crucial protection in an effort to slash the NYS budget. The Governor is further proposing the removal of prescriber prevails for all drug classes in Medicaid. This can have a devastating effect on our community members. The Mental Health Association of Rockland has the privilege of serving more than 1000 people a day, affected by mental health and substance abuse issues. We have seen the pain caused by repeated medication changes, lack of access to appropriate care, and compromised care when doctors are not the ones making treatment decisions in concert with their patients. We are therefore joining Senator Carlucci in his call to restore prescriber prevails to the New York Medicaid budget.
Stephanie Madison, LMSW
Mental Health Association of Rockland County