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In the last edition of Voices, we called upon readers to make their voices heard with their elected representatives with regard to the proposed Preferred Drug Program (PDP).

The PDP was designed to save tax dollars by creating a formulary of medications to which Medicaid recipients would have access, placing those drugs on a list of 'preferred' medications. This proposal caused great concerns for Medicaid recipients living with mental health needs who could likely have been left without access to vital mental health medications. While the PDP was included in this year's budget agreement, due in large part to the fact that Voices readers weighed in with their representatives, significant improvements and safeguards were included in the final PDP agreement.

Among the most significant victories was the inclusion of 3 consumer representatives on the Pharmacy & Therapeutics (P & T) Committee, which is charged with determining which drugs shall be 'preferred.' This is a huge victory that will empower consumers in the decision making process - a process that will ultimately impact consumers' ability to access medications.

Another important provision will allow doctors to have the final say as to whether or not a patient will get a drug on the 'preferred' list of medications. The doctor must follow a detailed process in which he/she must call or fax the PDP's administrators and consult with healthcare professionals to obtain permission to prescribe a 'non-preferred' drug. If, after the doctor has plead his/her case, and the patient does not meet any of the criteria necessary for prior approval, if it is in the prescriber's "reasonable professional judgment...that the use of a prescription drug that is not on the preferred drug list is warranted, the prescriber's determination shall be final." This represents a significant victory for Medicaid consumers, ensuring that medication decisions will remain with doctors and their patients. However, concerns still exist about whether this process of obtaining prior approval for non-preferred drugs will prove to be too time consuming and/or too much of a hassle, given the constraints under which many doctors that accept Medicaid currently operate.

In addition, if a doctor's request for prior authorization is not completed in 24 hours as a result of the program's failure, permission to prescribe a 'non-preferred' drug will immediately and automatically be granted. If prior authorization is not completed in 24 hours for other reasons, a 72 hour supply of the medication will be granted.

As the Governor recommended, all atypical anti-psychotic and anti-depressant medications will be exempted from the PDP. Additional language will provide the P & T Committee with the option to recommend that other therapeutic classes of mental health medications be exempted as well. Even with these exemptions and additional optional exemptions, there are still concerns about how individuals taking other mental health medications (i.e. mood stabilizers) will be impacted. In addition, the PDP will negatively impact individuals with co-occurring mental health and physical health needs, as drugs for most physical conditions will still be subject to the PDP.

Lastly, while refills for previously approved 'non-preferred' medications will not require prior authorization, the accessibility of mental health medications that come in different delivery modes (i.e. injectibles or patches) remains uncertain under the PDP.

All in all, while no PDP would have been preferable, it was due to the fact that Voices readers and others weighed in with their elected representatives that appropriate safeguards for Medicaid patients with mental health needs were in included in the PDP agreement.

Yet, as the implementation phase now begins, it is alarming that the P&T Committee has met and acted despite the fact that the 3 consumer representatives guaranteed in the budget have not yet been appointed the P&T Committee. Once again, we must call upon people to call, write or e-mail their elected officials, especially the Governor, to demand that the consumer representatives required by law be appointed before the P&T Committee continues its work.