Numbers Argument Against Patient Protections Doesn’t Make Sense

Yesterday, the Associated Press published a story on the difficulties that Medicaid recipients are experiencing in accessing prescription drugs since October 1, when the program was moved into managed care. Patient advocates are fighting to restore a provision that allows health care providers to ultimately prevail with health plans when prescribing prescription drugs. This struggle is based on the belief that doctors are in the best position to make medical decisions on behalf of patients in their care.

The fascinating part of the story is the incongruous (or inconsistent) information supplied by the Cuomo Administration and his Health Department. The Administration claims that allowing Medicaid recipients to access drugs as prescribed by their doctors will cost state taxpayers $25 million to $30 million a year. Compare this with the statement by the Health Department spokesperson, Michael Moran, who said that since reviewing several Medicaid managed care plans, “…less than half a percent of drug claims are denied after an appeal is made.”

What is the truth here? If so few denials occur after an appeal, how could clarifying the rights of health care providers and Medicaid recipients possibly cost $25 to $30 million per year?

In 2010, before managed care and when the state allowed prescribers to make final decisions, the Times Union quoted the Health Department as stating that out of 50 million annual prescriptions, doctors were able to prevail 3,000 times, or .006 percent of the time. ┬áThat’s similar to the current rate quoted by Mr. Moran. ┬áThis means that to achieve $30 million in fully annualized savings, each of the 3,000 prescriptions would have to cost $10,000, on average.

The numbers fail to make sense.  Journalists and policy makers should demand that the Cuomo Administration get their facts straight.

-Jaime Venditti, 3/12/12