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Change to Medicaid Drug Coverage in NY Budget Would Hurt People Living With HIV

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Gay Men's Health Crisis (GMHC) firmly opposed the state budget proposal to subject HIV anti-retrovirals, anti-psychotics, anti-rejection drugs and anti-depressants to prior approval. However, these medications were taken off the prior approval exemption list in the final New York budget. This means patients will need to seek approval from Medicaid before receiving medications recommended by their physicians unless their medications are on a predetermined list. This adds another layer of bureaucracy and delay to an already complex system.

Most of our 11,000 clients rely on Medicaid. The Legislature must now take action to correct this mistake and protect patient access to treatment by passing legislation introduced by Assembly Member Deborah Glick, A.1962, and Senator Joseph Robach, S.564, that would prohibit Medicaid's use of any prior approval or preferred drug list requirement for AIDS, HIV infection or Hepatitis C.

HIV/AIDS treatment can be very complicated given severe side effects and interactions with other medications. Individuals with complicated multi-system diseases take a multitude of medications to stabilize and treat their conditions. Not all individuals receive the same therapeutic benefit from non-brand medications. Immunosuppressant drugs are not always equivalent; what is tolerable for one individual may not be in the next.

GMHC also urges the legislature to correct the elimination of current "prescriber prevails" patient protection for Medicaid recipients in Managed Care starting in October 2011. The ultimate decisions regarding patients' drug regimens should rest with the prescriber, not the State Health Commissioner, who has absolutely no familiarity with a patient's health status.

Our clients and their health care providers already struggle with the Medicaid maze. We cannot support proposals that will reduce access and create unnecessary barriers to care.

By ignoring revenue options and cutting taxes for the very wealthy, New York's budget appears to have been balanced on the backs of our most vulnerable citizens. The Legislature and Governor need to correct this oversight expeditiously.