Partly due to the hard work of our New York patient advocates, as of July 1, 2013, the patient’s health care provider is the decision maker, not Medicaid, about prescribing medically necessary prescription drugs in many categories relevant to lupus treatment. Providers must still document the need for any medication, but Medicaid Managed Care plans will provide a three-day temporary supply of medication when necessary. Please check http://www.newyorkhealthworks.com/wp-content/uploads/2013/06/Expand-Prescriber-Prevails-6-4-13.pdf.
Also, as of July 8, 2013, it will be easier for managed care healthcare providers to submit a request for Medicaid approval of coverage for their patients’ medications. The same form will be used by Medicaid Managed Care, Family Health Plus and Medicaid Fee for Service. For more information see this memo from the NYS Department of Health http://www.newyorkhealthworks.com/wp-content/uploads/2013/06/Standard-PA-Form-2.pdf . The form will be available for Managed Care plans at http://pbic.nysdoh.suny.edu and for Fee For Service at https://newyork.fhsc.com.