How Prescriber Prevails Works

This year, the Governor’s Executive Budget is trying to eliminate a protective provision in the New York State Medicaid managed care and Medicaid fee-for-service program. This provision, known as Prescriber Prevails, protects patients and ensures they have access to the medicine their doctor or other health care provider knows is the most effective treatment for them.

Here’s what you need to know about Prescriber Prevails: 

  1. Prescriber Prevails is a provision in NYS Medicaid law that gives medical providers and patients the right to have final say when it comes to medical decisions.
  2. This means that when it comes to disputes with Medicaid about covering medications prescribed to patients, your doctor or other health care provider has the final say when they can prove a specific medication is medically necessary. This provision only applies to a selected group of medications.
  3. Any restriction put on the types of medications available for proper patient treatment is an obstruction placed in front of you and your doctor that prevents you from getting the medical care that you need.

Tell your legislator TODAY to protect Prescriber Prevails in the New York State budget! Take action here.