New Medicaid rule may hurt needy

WASHINGTON – An obscure provision slipped into a $120 billion Iraq spending bill in May threatens to leave some poor and disabled Medicaid recipients without prescription drugs in October.

In a case of unintended consequences, Congress inserted a rule cracking down on Medicaid fraud that requires that all non-electronic prescriptions for Medicaid patients be written on tamper-resistant paper.

Devised as a way to raise nearly $150 million over five years for public hospitals, the requirement has been criticized as too much, too soon by pharmacists, doctors, patient advocacy groups and state Medicaid officials. They say doctors could leave Medicaid, pharmacists could lose money and patients could be denied drugs.

“Nobody really knew where this came from,” said Jamila Edwards of the California Primary Care Association. “The patient’s going to be in the middle thinking, ‘How come I didn’t get my medication?’ “

If a patient has a prescription on the wrong type of paper, pharmacists can fill it while seeking the prescriber’s confirmation by phone, fax, e-mail or tamper-proof paper within three days. Jeffrey Kelman of the Centers for Medicare and Medicaid Services said that should protect patients from being denied needed drugs.

Doctors, pharmacists and patient advocates say the new federal rule can’t be implemented by Oct. 1. They warn that pharmacists could be forced to return Medicaid payments if they fill prescriptions improperly, and patients could be denied medications if the prescriptions aren’t written on tamper-resistant pads. “In our state, very few doctors use these kinds of pads,” said Doug Porter, the Medicaid director in Washington. “I think some people will be denied service, and that will be a very bad situation.”

Must-pass legislation such as May’s spending bill for the wars in Iraq and Afghanistan usually attracts unrelated amendments. In this case, Senate Majority Whip Dick Durbin, D-Ill., won a one-year delay on a federal rule that would limit payments to public hospitals. Under Democrats’ budget rules, it had to be paid for, and the Medicaid fraud crackdown was chosen.

Twelve states already require the use of tamper-resistant pads in some instances, including for heavy-duty narcotics such as morphine and OxyContin. New York requires it for all prescriptions.

Tom Clark, a lobbyist for the American Society of Consultant Pharmacists, sees the new rule as a threat to the elderly and poor Medicaid patients. “I suspect it’s going to be pretty chaotic,” he said.