The bill allows MCOs to deny prescriptions recommended by a physician, if there is a cheaper drug available that could first be tried. (The bill would apply to prescriptions written starting July 1, 2016, effectively grandfathering in all prescriptions written before then). So the greatest impact will be on newly eligible persons or newly diagnosed medical needs, on and after July 1.
SB 341 is maybe the clearest policy signal we have seen in our new managed care world that the medical interests of persons served take a back seat to budget considerations. In effect, a decision is made in this bill that will hurt those with the most complex prescription needs, and it is going forward because they need to cut the budget to compensate for their poor planning and fiscal decision making.
The effort is to make the sun shine in Kansas, even if it means darkening the future for persons in need.
SB 341 does not specifically protect mental health drugs, whether used for MH diagnoses or used for seizure prevention. It does require that prior to implementing step therapy policies for MH drugs that such policies would be required to go through an existing medical review panel which was set up last year. This is a modest assurance, but not an ironclad protection.
This process is complicated by the possibility that the bill cannot be fixed in the House because it will NOT be worked in a House committee. Instead, the tentative plan is to add SB 341 into another bill (not yet determined) to avoid a House debate on step therapy .. partly because they might lose such a debate, partly because they do NOT want a bill on the House floor which might be a vehicle for Medicaid expansion.
Contact your Senator ASAP, and ask that when they go to the floor today at 2:30 p.m., that they vote to protect the interests of Kansans. If you know your Senator's name - Click here to look up their contact information.
If you do not know who represents you, you can look up your elected officials here.
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