Prescription drugs for people living with compromised immune systems are more important than ever during this pandemic. But a little-noticed change set to take effect in New York could make it harder for people who need that medication as well services provided by non-profit entities.
At issue is a "carve out" in the Medicaid prescription drug program. State officials say it is expected to save $87 million as New York seeks to streamline a costly Medicaid program.
But advocates and non-profit groups warn this will have a wide-ranging effect on those who need prescription drugs, but struggle to afford them. And it would impact people with compromised immune systems who are most vulnerable during the COVID-19 pandemic.
"We would have to stop providing free medication to about a thousand underinsured patients a year," said Henry Bartlett, the vice president of governmental affairs and community relations at the Damian Family Care Centers. "That would mean patients would not get their HIV meds, their hep C meds, their substance abuse meds and a whole variety of other things."
And it would not be just medications, but services provided by groups like the Albany Damien Center, which is separate from Bartlett's organization.
"They will be going without meals," said Perry James Junjulas, the group's executive director. "They'll be going without food. They'll be going without support to enable them to get their medications to be able to get their doctors appointments."
Junjulas's group works with people who are living with HIV and AIDS. He says this would amount to a cut for services that people rely on as they struggle with the disease.
"It funds our food program, the meals we serve to people who are very low income, the most vulnerable of our community," he said. "It pays for mental health counseling. It also pays for their support to help people get their medications to help survive with HIV and AIDS today."
State officials have met with entities affected by the change and plan to do so again.
“The Medicaid Redesign Team II proposal to move the Medicaid pharmacy program from managed care plans saves taxpayers millions of dollars by increasing transparency, ensuring Medicaid pays the best price for medications, and eliminating unnecessary administrative costs to health plans, all while ensuring that consumers continue to have access to needed medications," said Health Department spokeswoman Jill Montag.
But Bartlett, of the Damian Family Center, said the savings would essentially cost the state more.
"To save that $87 million, they're going to give up at least $150 million in federal share Medicaid," he said. "So they're literally giving money back to the federal government that would serve the poor and they're blowing a huge hole in the safety net for the uninsured population."