June 21st, 2017|0 Comments
The sponsors of this bill have indicated it is intended to align the Medicaid Managed Care (MMC) prescriber prevails prior authorization (PA) process with that of the Medicaid Fee-for-Service (FFS) program. However, the MMC prescriber prevails PA process already aligns with the Medicaid FFS and federal law requirements. In addition to being unnecessary, the bill would have a negative impact on the state’s pharmaceutical costs under the Medicaid program. Accordingly, the New York Health Plan Association (HPA) opposes S.6541/A.4007.
Currently under the Medicaid program, both MMC and FFS utilize the same expedited, three business days from request, prescriber prevails PA process. The sponsors of the bill are under the misconception that the MMC program PA requirements regarding prescriber prevails differ from those of the FFS program. The process for prescriber prevails is the same for MMC as it is for FFS.
According to the December 2012 New York State Medicaid Update:
“Plans are required to meet specific federal determination timeframes in response to
requests for health care services. Consistent with these requirements, when the plan is
unable to complete a prior authorization due to missing information or because the
prescriber’s reasonable professional judgment has not been adequately demonstrated,
either by consistency with FDA approved labeling or use supported in at least one of the
Official Compendia as defined in federal law under Social Security Act Section
1927(g)(1)(B)(i), the plan will issue a notice of action to the provider and member.
Such notice will describe the information required to complete the authorization and the
member’s rights regarding appeals and fair hearings.”
This legislation would eliminate the requirement that prescribers provide documentation to support themedical justification for prescribing the medication. While the exact cost impact of this expansion ofbenefits is unknown, this legislation fails to appropriate funds for this increased state share of costs. It is important to note that any increased costs associated with this legislation will also have a direct impact on the Medicaid global cap.
For all these reasons, HPA opposes S.6541/A.4007.
June 20th, 2017|0 Comments
This legislation, S.6674/A.7979-A, seeks to prohibit health plans from requiring prior authorization (PA) for medication assisted treatment (MAT) for heroin/opioid addiction. New York’s health plans support MAT, but while this bill is well intended, the New York Health Plan Association (HPA) opposes the legislation because it includes prohibition of PA for long acting naltrexone, otherwise known as Vivitrol.
While buprenorphine and methadone can be used as the frontline treatment for heroin/opioid addiction, the same cannot be said for Vivitrol. In order to initiate treatment with Vivitrol, the individual must go through complete detoxification and have no opiates in their system, which includes buprenorphine and methadone. During the period in which the individual is undergoing the complete detoxification from all opiates in their system, between 7 and 14 days, there is more than adequate time for the treatment provider to comply with the plan PA requirements and determine if Vivtrol is the appropriate MAT for the individual.
In addition, Vivitrol is not appropriate for all individuals suffering with heroin/opioid addiction. On June 11, 2017 the New York Times published a story “Seizing on Opioid Crisis, a Drug Maker Lobbies Hard for Its Product” , which detailed serious concerns regarding the evidence supporting the use of Vivitrol. According to the article Vivitrol’s clinical trial was conducted in Russia, where regulations on clinical trials are lower in comparison to the United States. The clinical trial was against a placebo, rather than buprenorphine or methadone.
Dr. David Fiellin, an addiction specialist at Yale, stated “Due to their established efficacy, methadone and buprenorphine are on the World Health Organization’s list of essential medications….Naltexone and Vivitrol are not.” Individuals that use Vivitrol to control their addiction are at a greater risk of overdose if they begin using heroin/opioids again.
For these reasons, HPA opposes S.6674/A.7979-A.
June 19th, 2017|0 Comments
The New York Health Plan Association (HPA) supports A.516-A/S.2543-A, which seeks to strengthen New York’s Clean Indoor Air Act to further protect the public by prohibiting the use of electronic cigarettes (e-cigarettes) in the same areas smoking is currently prohibited.
Although promoted by some as safer alternative to cigarettes and a potential bridge to quitting, recently the U.S. Preventive Services Task Force (USPSTF) determined there’s not enough data to decide whether e-cigarettes can help smokers quit. Moreover, these products have not been well-studied, and their health risks are unknown.
In recent years, there has been a major increase in the use of e-cigarettes—particularly among adolescents. Researchers have found that more young people used e-cigarettes than conventional cigarettes and data from the Centers for Disease Control and Prevention show the use of e-cigarettes among middle and high-school aged American teenagers tripled from 2013 to 2014 and then doubled between 2014 and 2016. In 2014, the use rate was 10.5% and in 2016 the rate soared to 20.6%.
Managed care plans are founded on principles that emphasize primary and preventive care. As part of their comprehensive approach to health care, HPA member plans have long sought to educate their members and the general public on the dangers of smoking, in addition to helping members that do smoke quit. In concert with this philosophy, HPA has historically supported public policies that seek to reduce New Yorkers’ exposure to the harmful effects of smoking and create a healthier environment for all. Given the lack of information about the potential health risks posed by e-cigarettes—to both users and those subjected to the secondhand exposure to nicotine and other potentially harmful chemicals found in these products—protecting New Yorkers against the possible dangers is the best course of action.
Many localities across the state—including New York City, Erie, Suffolk, and Tompkins Counties—have already adopted measures restricting the use of e-cigarettes anywhere smoking of tobacco products are prohibited. A statewide standard on e-cigarette use in public places will ensure all New Yorkers received equal protections.
For the reasons outlined above, HPA supports A.516-A/S.2543-A.
The New York Health Plan Association, from time to time, responds to important health care issues or offers its views on current health care matters.
You can read these views in our letters to the editor and opinion-editorial (op-ed) articles.
April 5th, 2016|All News, Letters to the Editor|
In a letter to the editor, the New York Health Plan Association responds to criticism of health plan policies that seek to ensureappropriate prescribing in ... Read more
February 3rd, 2016|All News, Letters to the Editor|
A “Time for Affordability” letter to the editor of the Albany Times Union outlines ongoing concerns about rising health care costs and ideas for addressing ... Read more
August 18th, 2015|All News, Letters to the Editor|
In a letter to the editor, the New York Health Plan Association responds to a story on a Medical Society of the State of New York ... Read more
July 22nd, 2015|All News, Letters to the Editor|
A letter to the editor submitted by the New York Health Plan Association on July 22, 2015 and printed on July 30, 2015. Read Online ... Read more
June 6th, 2015|All News, Letters to the Editor|
In a letter to the editor, the New York Health Plan Association responds to an editorial and to recent stories about heroin and opioid abuse. ... Read more
February 1st, 2015|All News, Letters to the Editor|
In an op-ed commentary, the New York Health Plan Association speaks out about the effects of ACA reforms. Download the PDF