[NYAPRS Enews] DOH: Medicaid Will No Longer Pay for MH, Other Drugs not on Medicare Formulary

[Harvey Rosenthal]

NYAPRS Note: Please help educate Medicaid beneficiaries and providers
about another change in NY's Medicaid pharmacy program: the end of
'Medicaid wrap around' coverage for drugs in previously protected
classes (atypical anti psychotics, antidepressants,  antiretrovirals and
antirejection drugs used for tissue and organ transplants) that are not
on Medicare Part D's formulary (list of approved drugs). Prescribers can
still appeal to Medicare to reimburse for a drug in these classes that
is not on the Medicare formulary. 

 

Medicaid Benefits to Change for Medicare/Medicaid Dual Eligibles

 

Effective October 1,2011, the Medicaid program will no longer cover
drugs in the following drug classes when billed for full benefit
Medicare/Medicaid dual eligibles:

* Atypical anti psychotics;

* Antidepressants;

* Antiretrovirals used in the treatment of HIVIAIDS; and

* Antirejection drugs used for tissue and organ transplants.

 

Drugs in these classes must be billed directly to the Medicare/Medicaid
enrollee's Part D plan, or when applicable, to Medicare Part B. Prior
authorization or exception requests may be required by the Part D plan.

 

The New York State Medicaid Program will continue to cover certain drugs
which are excluded from the Medicare Part D benefit, such as
barbiturates, benzodiazepines, some prescription vitamins and some
non-prescription drugs. These drugs may continue to be billed directly
to Medicaid.

 

We strongly encourage prescribers and pharmacists to work with Medicare
Part D plans prior to October 1,2011, to obtain coverage of these drugs
and avoid interruption in their patients' drug therapy.

 

Please contact Medicare at 1-800-MEDICARE for information regarding
Medicare drug benefits. Questions pertaining to Medicaid drug coverage
may be directed to (518) 486-3209.

 

http://www.health.state.ny.us/health_care/medicaid/program/update/2011/s
ept2011mu_special1.pdf

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