This week, we are taking a look at proposals in several states that would change the way they administer the pharmacy benefit in their Medicaid programs – transitioning from traditional fee-for-service Medicaid to a managed care model. Today we look at what patient protections must be included in Medicaid programs. Earlier posts can be found here, here and here.
As states transition or consider transitioning the Medicaid pharmacy benefit over to a managed care system, policymakers and regulators must ensure the new program has the same protections in place for patients in need.
What kind? Fee-for-service Medicaid patient protections provide a clear example of the types of pro-patient policies that should also be included in a managed care Medicaid system.
These established policies provide an accepted standard of patient protection in the Medicaid system and are a road map to preserving good patient care.
The following standards must be adopted from fee for service to managed care:
Continuity of Care – If a patient is already being effectively treated with a specific medicine, they should not have to change medicines as a result of the state’s Medicaid policy. Often patients and doctors work together for a long time to find the best medicine for the individual patient. That progress cannot be lost and the patient should not be forced to endure a new medicine based on a government rule or guideline.
Prescriber Choice – A system must be included in managed care Medicaid plans that allows the expert opinion of a trained medical professional as to the best care for the patient to supersede the bureaucratic recommendation. This is paramount to good healthcare and the safety of the patient.
Public Input – The formulary for managed care Medicaid should be arrived at in a transparent way, creating an opportunity for the interested, knowledgeable public to have their input included. Patient advocates and healthcare providers have expertise, knowledge and experience that are indispensable when arriving at the best policies to provide healthcare to Medicaid patients.
Taken together, these protections will ensure patients will receive the care they need through the Medicaid program.