Hepatitis Health Care Access, Insurance & Medication WorkgroupMeeting Highlights
Joint committee meeting of the NYC Hep C Task Force & Hep B Coalition
October 25th, (3-5 PM) Long Island City Health Department Building: 42-09 28th Street (6-13)
Workgroup Webpage: https://hepfree.nyc/health-care-access-insurance-medications-workgroup/
Workgroup outcomes posted on webpages:  https://hepfree.nyc/resources/health-care/

Tentative next meeting: Tuesday January 8th (3-5 PM) Beth Israel Union Square

In attendance: Steven Linick (SteveL67@optonline.net); Adrian Lopez, Patient Navigator (Adrian.Lopez@mountsinai.org); Eric Rude (erude@health.nyc.gov); Fidel Contreras (fcontreras@betances.org); Yelena Mullokandova <ymullokandova@health.nyc.gov>; Nirah Johnson <njohnso2@health.nyc.gov>; Anastasia Teper, Check Hep C Patient Navigator (anastasia@vocal-ny.org); Evelyn Gomez, Patient Navigator (egomez@harlemunited.org); Celia Correa, Patient Navigator (CCorrea@chnnyc.org); Stephanie Darwak (sdarwak@cullarigroup.com); Marvin Siegel, Dir Clinical Services (marvin.s@TownTotal.com); Hadiyah Charles (hcharles@harmreduction.org)


Meeting Highlights

  • Celebrate Success! Governor Cuomo signed the Standardized Prior Authorization bill (A.10248B/S.7384A)
    Effective immediately, the new law requires the development of a standardized prior authorization form to be used by all Medicaid managed care providers when submitting utilization review requests to health plans.  The new form will be developed by the Department of Health and will be available in paper or electronic form.  The new law is designed to ease the burden experienced by providers and patients in navigating through the prior authorization processes of 21 different Medicaid managed care plans.

    • Group reported they have not yet seen a new uniform standardized form or a change due to the passage of this bill.
  • Update & Action Alert:
    • Preserving the right for patients to select the pharmacy that is best for them: Mail-order Pharmacy, Local Specialty Pharmacy
      • Approach: Legislation, Regulation or a combination of both?
      • Can Hep C Patients get an Exemption from Medicaid Managed Care Mail-order pharmacy during the time of treatment?
      • Is an Anti-Mail Order Pharmacy Law possible in Medicaid Managed Care as it has been in Private Health Insurance?

Action Plan

  • DOHMH staff will work internally with office of intergovernmental affairs to ensure the Commissioner of Health is aware of this issue and how it impacts Hep C Patients. Possibly will request an exemption from Mail-order pharmacy for Hepatitis C Patients while on treatment.
  • Community partners will work on collecting accounts from both medical providers and patients as to how mail-order pharmacy has cause a disruption in care
    • One option to collect feedback: Patient Feedback can be submitted through: Medicaid Survey for Patients about experience with medication coverage. New York Health Works. Chance to win $100!
    • The NYS Pharmacist Society is working on an Anti-mail order pharmacy law for Medicaid Managed Care. For further info, contact Steve Linick: SLinick@Echodrx.com
    • Sub-group will form specifically on this issue. If you are interested in getting involved, contact: Marvin Siegel, Dir Clinical Services(marvin.s@TownTotal.com)


  • Provider Prevails – Fidelis still not allowing prescription of one of the protease inhibitors.
  • Prior Authorization – outstanding issues
    • Prior Authorization process continues to be a very difficult problem
    • Use of a Local Specialty Pharmacy eases the burden of ordering medications for the Betances Clinic. Prime-A Pharmacy
  • Planning: 2012 Medicaid & Medicare: Special Issues Training. November 29th (10 -4) – NYC DOHMH
    • Will send out event invite by October 31st.

Revised Agenda – Based on Feedback from Meeting Participants

  • ‘Protecting the Rights of Patients without Insurance & Providing Access to Care’ – Community Health Advocates
  1. PRUCOL – Community Health Advocates
  2. Hep Cap – Jocelyn Camacho, Mount Sinai Primary Care Hep C Program
  3. Clinical Trials –  Possibly  TAG
  4. HHC Options – Identifying Speaker
  5. Examples of the Sliding scale costs at several community health centers (FQHCs)
    1. Community Health Care Network
    2. Charles B Wang
  • Medicaid Buy In Program for Working People with Disabilities – Community Health Advocates
  • Medication Coverage: Getting the Patients the Meds  – Adrian Lopez, Mount Sinai Hep C Primary Care Program
  1. Resolving Pharmacy Issues
  2. Patient Assistance Programs
  • Patient Navigator Panel
  1. Adrian Lopez, Mount Sinai Primary Care Hep C Program
  2. Tentative: Bellevue Hepatitis Clinic Patient Navigator
  3. Tentative: Citywide Harm Reduction Check Hep C Patient Navigator
  • The Affordable Care Act & Hepatitis: What can we expect? – Frank Winter, CMS
  • Tabling – Invitations will go out to:
  1. Medicaid Managed Care Plans
  2. Local Specialty Pharmacies
  3. A Legal Aid organization
  4. Hispanic Federation
  5. Facilitated Enrollers (Health Insurance)

New Discussion

  • Listserv will be developed to facilitate collaborative discussion between group members. Hadiyah Charles will manage.
  • Hepatitis Health Care Access for the Uninsured – identification & dissemination of existing resources – discussed as major focus of upcoming training
  • New Needs Defined/Identified:
    • Need for ‘Patient Assistance Program for Hepatitis Labs’ – to cover the cost of Hep B & C labs for the uninsured
      • Is anyone aware of existing programs that cover the cost of labs for uninsured Hepatitis patients, other than Hep-Cap?
    • Need for more ‘Hepatitis Healthcare Policy Advocacy Leaders’ – in order to really make progress
      • Currently Healthcare Policy work in this field is conducted as a side project.
      • Need identified by Adrian Lopez and Mount Sinai –  for successful programs to disseminate positive outcomes at conferences and with those in position to influence health policy. There are models that do work.

Tabled for Next Meeting:

  • Mission for Workgroup? (For outreach & awareness purposes)
  • Starting the Hepatitis Health Care Access, Insurance & Medications E-Alerts
  • Opportunity for meeting participants to bring newly identified obstacles to health care access, Insurance & Medication coverage to the workgroup’s attention

Our next meeting is tentatively scheduled for Tuesday January 8th – Possibly at Beth Israel Union Square.

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