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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 9 No. 1 |
February 2005 |
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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 9 No. 1 |
February 2005 |
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Prescription Drug Problems: Let's Fix Them!Have you ever been told that your doctor needed to get approval
- “Prior Authorization” (PA) -
from the Department of Health and Human Services (DHHS)
before you could get a prescription drug?
Because of Prior Authorization:
? Have you had delays in getting the drugs you need ?
? Have you been told to first try one or more drugs that don't work ?
? Have you had to go without any medication ?Both MaineCare and the Low Cost Drug Program for the Elderly and Disabled (also called “DEL”) require “Prior Authorization” before you can get many drugs. The number of drugs that need prior authorization has increased in the past year. This is because DHHS has had to look for ways to reduce the cost of the MaineCare program to help balance the state budget. This change has hurt many MaineCare members and DEL participants.
Last year, the Health and Human Services Committee of the state legislature heard about PA problems from consumers, advocates and providers. They set up a subcommittee of the MaineCare Advisory Committee (MAC) to get more in-depth information and to make recommendations. MAIN and Maine Equal Justice serve on this Subcommittee that recently sent recommendations to DHHS. The legislative committee will get our report and DHHS's reaction to the report in February.
State Senator Michael Brennan of Portland has submitted a bill to make sure that problems with PA are addressed and fixed. Some of the specific areas the bill covers include the following:
Require DHHS to provide consumers with easy to understand information;
Reinstate the rule that allows MaineCare members to get a one-time 34-day supply of drugs if their doctor doesn't submit a PA form on time;
Exempt some people from the PA requirement (for example, MaineCare members with dementia who can't communicate adequately about their health care needs);
Streamline the paperwork that doctors need to fill out;
Make the decision-making process of the Drug Utilization and Review Committee (the committee that decides which drugs will need PA) more open to public input;
Speed up the fair hearing process; and
Monitor the effect of these reforms.
The subcommittee's report has good information, statistics and recommendations for the legislative committee. But the best way for them to understand how the PA policy affects MaineCare members and DEL participants is to hear from you.
Please let us know...
if DHHS has told you that they won’t pay for a drug that your doctor thinks you should have.
Contact Crystal Bond at Maine Equal Justice:
1-866-626-7059, ext. 205
