Health care advocacy organizations are calling for Gov. Andrew Cuomo to sign a bill on his desk that would help ensure doctors have the ultimate say over what medications their patients take.
If your doctor prescribes a medication, your insurance will cover it. Right? That concept is called “provider prevails.” In other words, the medical provider gets to be the judge about what drugs the patient should take.
That authority particularly matters for people living with AIDS, epilepsy, and certain mental health conditions who take expensive medications.
The legislation ensures that Medicaid managed care plans adhere to the same rules as other plans.
Patrick Pullano, a health care attorney based in Rochester, says the bill strengthens laws already in place.
“Since these are drugs for, you know, a particular population, I think that there was a concern that those individuals in that population wouldn’t have as easy access when there was a medical need for these drugs,” says Pullano.
According to the Schuyler Center in Albany, previously Medicaid managed care plans had the power to block prescriptions and demand additional proof of the necessity of the treatment.