BUFFALO, NY (WKBW) — The state launched a new Medicaid program called NYRxon April first. The program allows the state to pay pharmacies directly for drugs and supplies for eight million Medicaid members.
But a Medicaid recipient is crying foul saying so far, she’s lost access to her insulin drug.
“It's very upsetting. I don't know where to go from here. I am at a loss,” declared Devin Swader.
Devin Swader of Medina is desperately waiting for her insulin drug to treat her type one diabetes. She's on Medicaid, working part-time as she completes her nursing program this May. But with the new NYRx program, Swader says she's been blocked from getting her medication for her insulin pump.
“But now they're saying that it's a 30-day wait for prior authorization and 30 days — you can't wait 30 days for something you need — insulin — I can't go without it for more than a couple of hours,” Swader explained. “I actually had a call from my pump company yesterday saying that they no longer are going to be able to send supplies.”
NYRx now allows the state to pay pharmacy costs directly, eliminating managed care organizations. The program is designed to provide improved prescription drug access for all Medicaid clients.
“When I called Medicaid, I was trying to get numbers, so they can process the prior authorization. They were saying I don't need new numbers. My endocrinologist was saying I need new numbers, that the numbers I had will deny my supplies and then they won't be able to resubmit it until they go through this whole entire list of everybody else and I can not wait days, weeks, months without this stuff,” noted Swader.
Pharmacist Don Arthur tells me that pharmacists are totally in support of this new program.
“The launch has been great, you know, New York State. They've been working on this program for two years. We've been on webinars weekly,” Arthur remarked.
Arthur owns the Brighton-Eggert Pharmacy in Tonawanda and Black Rock Pharmacy in Buffalo. I asked him why Swader might be having trouble.
“You know if there are isolated problems, and there will be, when you're talking about transitioning, and they were transitioning not just from one plan, they were transitioning from a Blue Cross plan, an Independent Health Plan, or going to Univera plan. Depending on who her pharmacy provider is, there are some steps and hoops that we have to jump through initially to get some of these difficult medicines to go through,” replied Arthur. “Diabetic patients — they can't have a lapse of coverage. They can't have a lapse of therapy. New York State absolutely understands that.”
“I read an article that was by the governor saying it was going to be a seamless process. This is not a seamless process,” Swader described.
I reached out to the New York State Department of Health (NYSDOH) which issued the following written statement:
“NYRx will streamline the process for practitioners. Instead of working through varying rules and limitations for coverage under managed care organizations, pharmacists and physicians will be able to prescribe medication based on a uniform list that is less restrictive and governed by an independent public board of experts."
NYSDOH
The DOH also offered contact information for anyone who needs answers:
- Medicaid recipients or others with questions or in need of assistance with NYRx may visit the program's website
- Email nyrx@health.ny.gov
- Contact the Medicaid helpline at 1-855-648-1909 or tty 1-800-662-1220. The helpline is available 8 a.m. to 8 p.m. Monday through Friday, and 9 a.m. to 1 p.m. on Saturday.
