Grant: Cut through red tape on prescriptions
It happens far more often than it should.
A patient goes to the pharmacy to pick up a refill of an important medication prescribed by her physician only to be told by the pharmacist that her insurance plan no longer covers that drug.
Situations like these leave patients facing difficult decisions. Does she pay full price out-of-pocket for a prescription that’s always been covered before? Does she try to work it out with her insurance carrier or call the physician’s practice to have them change the prescription, leaving the prescription behind and missing critical doses of the drugs she needs?
Gaps like this in patients’ coverage can happen when health plans change their prescription drug formularies, or when patients switch health plans. A formulary is the list of medications that have been approved by the health plan. Since most pharmaceuticals these days are safe and effective, prescription formularies are usually based on cost of the drugs, discounts and rebates negotiated by the plan. For Medicaid patients, the problem can be even more pronounced.
That’s why Michigan physicians strongly support a recent proposal by the Michigan Department of Community Health (MDCH) to dramatically simplify the process for Medicaid patients to get the prescription drugs they need by streamlining Medicaid prescription drug formularies.
Today, every Medicaid health plan in Michigan has its own formulary for covering drugs. Those dozens of formularies change frequently.
Under the new plan by MDCH, a part of the 2015-2016 state budget proposal, each of the state’s Medicaid patients would be covered under the same prescription drug formulary, which determines which prescription drugs are covered by a patient’s health plan. The move would ensure patients get the drugs they need more quickly, easily, and with fewer interruptions.
Michiganians have better things to do with their days than navigating endless automated telephone prompts with their health plans and follow-up with the doctor for a new prescription just because of a formulary change in Lansing.
Under the current system, Michigan physicians often find themselves spending countless hours rewriting prescriptions or checking formularies. Physicians’ staffs also spend countless hours each year navigating the many different Medicaid formularies to match patients’ coverage with the drugs they need. That drives up the cost of health care and increases wait times for all patients at the doctor’s office.
The single-formulary reform proposed by MDCH would go a long way to address these problems for Medicaid patients.
MDCH estimates it will save taxpayers $65 million a full year by helping the state get the most bang for its buck through bulk orders and discounts.
Lawmakers should embrace this common sense proposal immediately, to cut red tape, and to simplify the prescription drug process for Michigan patients.
Dr. James D. Grant is president of the Michigan State Medical Society.