Georgetown Study Exposes Medicaid Reform Prescription Drug Problems

August 1, 2007

In the third of a series of webcast presentations, Dr. Jack Hoadley, of the Georgetown University Health Policy Institute, reported on a specific set of challenges faced by Medicaid Reform consumers. The report, accompanied by the briefing “Uncertain Access to Needed Drugs: Florida’s Medicaid Reform Creates Challenges for Patients” depicts a system in which most Reform HMO’s take full advantage of their right to limit the drug benefits and, by doing so, often create additional obstacles to health care access for Medicaid consumers.

The study focused on HMO’s rather than Provider Service Networks (PSN’s), Hoadley explained, because “3/4 of Broward's and 2/3 of Duval's reform enrollees are in HMO’s. In addition, PSN’s still operate under the old fee for service model, so they continue to provide medicines according to the state’s formulary,” he said.

Conducted over a period of 3 months earlier this year, the study seems to indicate that Medicaid Reform has had a particularly troubling effect on those who suffer from mental illnesses. “Reform allows plans to make substitutions. In some instances mental health drugs, such as atypical anti-psychotics, are not covered by the plans and switching patients (to other medication available through the plans) causes them to become unstable. Different drugs may not work as well and the consequences of switching are greater,” he said.

The disabled, who often take multiple prescription drugs, are also disproportionately affected by Reform. The pressure on plans to maintain a lid on costs may, over time, create additional barriers to access to medicines.

One of the biggest ongoing problems Medicaid consumers face in trying to determine which plan is best for their needs, is that the Choice Counselors, who are supposed to help them decide, have no access to the plans’ Preferred Drug Lists (PDL’s). This issue, raised by advocates from the earliest days of Reform, prevents consumers from making informed choices at the beginning of the enrollment process. “They instruct callers to contact the plans to get the formularies,” said Hoadley. The problem with this is that most plans provide their formularies online, but many Medicaid consumers have no access to the Internet. “It is challenging to get the information from the plans, difficult to find and use the lists,” Hoadley said.

In response to a participant who asked why Choice Counselors had no access to the plans’ PDLs, Hoadly reiterated the positions taken publicly by Director of Medicaid Tom Arnold and Director of AHCA Dr. Andrew Agwunobi that, “Choice Counselors do not have the necessary training to provide callers with prescription drug information.” Hoadley added, however, that “Counselors who help consumers with choosing Medicare Part D plans do provide (PDL’s), so there is a federal precedent. Why not allow Choice Counselors to just provide lists of drugs available?” he said.

The reports by Georgetown University on the effects of Medicaid Reform in Florida are funded by the Jessie Ball duPont Fund. Visit http://hpi.georgetown.edu/floridamedicaid/ for the full set of reports.

(Submitted by Andrew Leone, Florida CHAIN)


We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com.

www.floridamedicaidreform.org