Thousands of cancer patients enrolled in Medicaid in New York state face an additional hurdle that could affect the efficacy of treatment designed to save their lives.
Cancer and HIV patients across the state can get their oral medications directly from their doctor’s dispensary.
But the state health department implemented policy changes this year that make it harder for those dispensaries to get Medicaid reimbursements. This forces many cancer patients to use mail order pharmacies – delaying their prescriptions by days or weeks.
“We need to ensure that people fighting cancer get timely access to their cancer care — the care that saves their lives,” said Sabrina Mosso, executive director of Oncology Hematology of New York.
The change took effect on September 1.
Doctors, members of the New York Hematology Oncology Association and lawmakers gathered outside the state Capitol on Wednesday, calling on the state health department to change the policy.
Dispensing doctors and medical practitioners have been encouraged to enroll as “prescribers” in Medicaid, but can’t because the state Department of Education doesn’t license them with regular pharmacies.
“Obviously, they probably haven’t really understood, maybe, what the implications of trying to change policy are,” said Nancy Egerton, director of pharmacy at New York Oncology Hematology.
The state Medicaid program sent letters to doctors this summer alerting them to the change.
It’s a personal battle for MP Pat Fahey, whose son, Brendan, died after a 20-month battle with a rare cancer earlier this year.
“I know firsthand what a race against the clock it is when you’re dealing with oncology, prescriptions and related medications,” she said. “…Every day counts. I can’t even tell if my son was a Medicaid patient instead of having insurance.”
Egerton says NYOH had helpful conversations with the Department of Health two years ago when the changes were being negotiated and later shelved. But the impact of those discussions has been lost amid changes in DOH leadership since then.
Health Department officials on Wednesday stressed that the Sept. 1 changes were made to comply with the federal 21st Century Cures Act, which requires all Medicaid managed care providers to be enrolled in the Medicaid program to continue to provide services.
“This is unequivocally false because there has been no change in Medicaid policy,” Department of Health spokesman Jeffrey Hammond said in a statement. “In fact, every Medicaid patient still has the option of getting their oral prescriptions directly from their doctor, and Medicaid reimburses all prescribers for the drugs dispensed to patients.
Physicians in the state are not licensed or registered as pharmacies and cannot be enrolled as a pharmacy provider in the Medicaid program.
“There is no change or restriction on access to these drugs for doctors or their patients,” Hammond said.
Dispensers and medical practitioners have never been specifically defined in state law, leaving a gray area when it comes to licensing and regulations. Billing doctors and providers like pharmacies would require a change in state education law.
Assemblyman John McDonald III, a pharmacist of several decades, has been working to bring the Department of Health, health care providers, oncologists and others together to talk and find a solution.
Legislation to change the policy would take many months — time that advocates say cancer patients don’t have.
“I think creating a limited pharmacy license for this particular small window of claims in New York State and their small practice makes perfect sense,” said McDonald, a Cohoes Democrat. “But like anything else, what I think is simple is not always so easy.”
About 7.3 million New Yorkers were enrolled in the Medicaid program last December, said National Community Cancer Association Executive Director Michael Reff.