Important News about Medicaid Managed Care & Hepatitis C Treatment Access

Today, you can still access HCV specialty medications from your local neighborhood pharmacy but – THIS RIGHT IS AT RISK of being taken away!

Tens of thousands of New York’s most vulnerable patients enrolled in Medicaid managed care plans are being forced to use mail order pharmacies to fill their HCV specialty prescriptions.  This policy is detrimental to the long term medical outcome for chronically ill marginalized patients living with hepatitis C (HCV).

The Problem: The mail order process requires a prior authorization approval that can result in major lapses in HCV therapy.  Lapses in HCV therapy can be potentially dangerous, even life threatening. Published data suggests that if patients miss as few as three doses of their HCV therapy, they are at risk for developing resistance to HCV medications.  If and when prior authorizations for HCV specialty medications are approved there are still several issues accessing the medications. Deliveries are not coordinated to the schedules of the patients and medication left outside of a patient’s home is at risk of theft or may be rendered ineffective if it is exposed to heat or cold. Due to the sensitive nature of medical information, many patients are uncomfortable having family members or neighbors accept deliveries of medicine if they are not at home.

Patients enrolled in Medicaid managed care plans may already be marginalized or otherwise vulnerable and some require individualized consumer education and adherence counseling tools that are not provided by mail order providers. With the mail order process no one is there to assist, educate or teach chronically ill patients how to take their medications.

Earlier this year, Governor Coumo passed the Anti-Mandatory Mail Order statute (AMMO). The AMMO prevents commercial insurers from forcing patients to use mail order plans.  The Governor stated the measures would “improve consumer convenience by expanding the options by which consumers can fill their drug prescriptions.”  There is no AMMO protection setup for patients enrolled in Medicaid managed care plans – they are not given a choice. Patients in Medicaid managed care plans must be afforded the same AMMO protection given to patients with commercial insurance.

The temporary solution: A temporary injunction has been implemented that allows people with New York State Medicaid to retain the right to use the pharmacy that best meets their individual needs.  This temporary injunction was granted in order to determine if, like the AMMO statute, restrictions to mail order pharmacies are detrimental to Medicaid recipients as well.

Action Alert! Have you experienced problems accessing your HCV specialty medications?

If so please email a description of what happened to the  New York State Department of Health Pharmacy Program that oversees Medicaid Managed Care Pharmacy Services.


For more info:

Hadiyah Charles, MA
Hepatitis C Advocacy Manager

Harm Reduction Coalition
22 W. 27th Street, 5th Floor
New York, NY 10001
(P) (212) 213-6376 x30
(F) (212) 213-6582

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Last Updated on January 25, 2020 by HepFree NYC

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