Advocates make another push to stop prescription drug change

The way you receive your prescription drugs and care under Medicaid is going to change.

Starting April 1, the state is switching to a new model called NYRx.

The changes have one local health organization on edge, and even the state’s Medicaid director tells 13 Investigates why he understands their concerns.

New York state leaders said they’re going back to the basics when it comes to Medicaid. The state will soon offer what some lawmakers say is an improved, equitable, and simplified process for patients to get their medicine.

Assemblyman John McDonald (D – Cohoes), who is also a pharmacist, said Medicaid members will receive their prescriptions through NYrx. 

“What this program does is it gets away from the way I see programs, as a practicing pharmacist, a lot of formulary exclusions, a lot of drugs not covered, a lot of prior authorization. Which can be delaying patient care.”

McDonald said this allows the state to take out the middleman and pay pharmacies directly. It’s largely known as the Medicaid carveout.

But not everyone is on board.

“We should just really stop and just really give this a good look,” Perry Junjulas said.

Junjulas, the executive director for Albany’s Damien Center, said the carveout is going to have a detrimental impact on a federal program, known as 340B. It serves vulnerable communities, such as the HIV and aids populations.

Junjulas said about a quarter of his $3.5 million budget is going to get cut. He said this will force him to cut some services.

“I am unsure of what I’m supposed to do because they have not had any substantial conversation with us about how they’re going to make us whole and keep us whole,” Junjulas said.

Amir Bassiri, New York state’s Medicaid director, said he can understand Junjulas’ concern given the state’s past track record. 

“We have tried to communicate that as clearly as possible. I can understand the hesitancy with trusting this state from status quo,” Bassiri said.

Bassiri said the plan is to reinvest the majority of savings, being made through NYrx, back into the hands of 340B providers.

Bassiri said the goal is the Damien Center won’t see a change in its budget. In fact, he said the Damien Center will have fewer expenses from running a 340B program. 

“I can certainly understand the concern perry has. As I’ve told Perry [Junjulas], and the other Ryan White centers, they are the primary focus of all the solutions we’ve wanted to identify, to ensure minimal disruption for those clinics,” Bassiri said. “We believe in the services that they’re delivering for the vulnerable populations. Without question, I can guarantee that we will ensure there is no disruption with the Ryan White clinics.”

McDonald agrees, 340B programs will be better off in the long run.

“If I’m the administrator who sees this steady stream of revenue coming in, it’s hard to argue and see it the other way,” McDonald said. “There will be hundreds and hundreds, if not more, millions of dollars of which we can plow that back into help support those entities.”

There are 8 million people in the New York state that are covered under Medicaid and will benefit from NYrx. Including the 250,000 benefitting from 340B.

The Damien Center, and many other health organizations just like it, will not give up their fight. Now, there’s a new bill to try and repeal NYrx.