As Colorado begins to implement a new preferred drug list for Medicaid patients, the state must not lose sight of the sensitive medical needs of some of our most vulnerable populations. Without strong and decisive action as the list is implemented, thousands of our fellow citizens could be placed at risk.
Gov. Bill Ritter deserves great credit for focusing such strong attention on health care for vulnerable Coloradans. As the new list is implemented, we will work closely with the administration to ensure that the Medicaid population continues to receive the life-saving medications that they need and deserve. Unless we all focus on this critically important population, their health could be jeopardized as the list is implemented.
How?
It’s a well-known fact that, left unchecked, such lists focus on the economics of prescription drugs over the efficacy of individual medications. Many Medicaid patients must receive specific drugs that cannot be supplanted by generic substitutions.
In fact, if these patients are shackled to a narrow formulary of drugs, they could be forcibly switched from the medication their doctor believes they need to one prescribed by the list. The effects of changing medications in patients with complex conditions could easily result in higher health care costs.
We can avoid these dangerous outcomes if the list is constructed to establish as many protections as possible to protect patient care. These common-sense safeguards are essential to ensure that the most vulnerable among us are taken care of. Among the essential components that should be included are:
Patients and physicians must have a reliable and transparent process to appeal decisions to deny coverage for essential medications – a process that includes their input.
A priority must be placed on “continuity of care,” which protects patients from having a state bureaucrat suddenly decide that their current medication is no longer authorized. Patients should not have stops in their drug therapy, unless their physician, not the government, decides it is appropriate.
Prior authorization, which is the process by which medications must be approved by state officials before patients can have access to them, must be limited. It should not apply to the most vulnerable populations, including the mentally ill, people with HIV/AIDS, the developmentally disabled, people with complex and rare health care conditions, or people with cancer, epilepsy and hemophilia.
These patients need immediate access to prescription drugs when their health care provider has determined a change in treatment is necessary.
Physicians must have choices under the list of the drugs they are able to prescribe. The state should guarantee that “multiple choices” of drugs be included in each therapeutic class on the list and that doctors have the ability to write “Dispense As Written” on the prescription to ensure patients have access to the medication they need when it is prescribed.
Establishing a pharmaceutical and therapeutics committee, which would include client and advocate representatives, that will decide what therapies should be included in the list. The committee should be subject to open meetings laws, ensuring full public participation in its decisions. The committee’s criteria for including therapies on the list should be efficacy and safety and not cost.
To safeguard quality care for our state’s Medicaid population, it is essential that each of these important priorities be addressed in the state’s list. We are eager to be involved in the planning and development of this major addition to healthcare programming in Colorado. If the list is developed carefully and cautiously, it could serve as an important tool to save taxpayer dollars and protect the health of vulnerable patients at the same time.
Julie Reiskin is executive director of the Colorado Cross-Disability Association and Eileen Doherty is executive director of the Colorado Gerontological Society.
