March 6, 2012 — New York health insurers will lose state Medicaid contracts if they deny coverage of brand-name contraceptives, unless lower-cost, generic versions "fail first," the state warned on Monday, AP/U-T San Diego reports.
The warning came after the Associated Press reported that some female beneficiaries were told they would have to switch to lower-cost contraceptives unless those versions first failed to prevent pregnancy or resulted in bleeding or nausea (Gormley , AP/U-T San Diego, 3/5). The problem appeared to stem from a rule issued as part of a state Medicaid cost-cutting effort, according to the AP/U-T San Diego.
Under a rule that took effect Oct. 1, private health plans in New York's Medicaid managed care program are required to use generic drugs whenever possible. The state sought to substitute a generic birth control pill for more costly types of contraceptives, such as the monthly NuvaRing or weekly patch, according to the AP/U-T San Diego. Some health plans had denied coverage of the more costly contraceptives, citing the rule (Gormley , AP/U-T San Diego, 3/5).
"If a health plan is not attentive to the needs of its patients, they will no longer be a contracted health plan with New York's Medicaid program," James Introne, state deputy secretary for health, said, adding, "If there is resulting patient discomfort with a health care plan or its policies, it is a situation that the state will remedy." He said that there have not been "a significant level of complaints," but added that ensuring a "woman's ability to access birth control is a priority" for the state (Gormley , AP/U-T San Diego, 3/5).