Medicaid recipients have lost access to physician dispensaries for critical lifesaving medications

ALBANY, N.Y (Oct. 12, 2022) — New York Oncology Hematology (NYOH), the leading provider of community-based cancer care, united with doctors, nurses, cancer care specialists, advocates, community leaders and elected officials from around the state to advocate for Medicaid patients access to oral cancer medication through physician dispensaries.

In Sept. 2022, the New York State Department of Health (NYSDOH) made a policy change related to the New York State Medicaid system. This policy change eliminates Medicaid patients access to physician dispensaries. This change drastically impacts the quality and safety of treatment plans oncologists have established with thousands of New Yorkers.

“NYOH is committed to working toward a resolution that is fair and equitable for all,” said Sabrina Mosseau, executive director, NYOH. “Physician dispensaries are an important component in a patients’ treatment plan. We need to ensure services like this thrive, so that individuals battling cancer can receive the timely and quality care they deserve.

“We are extremely disappointed and upset with this policy change. It leaves Medicaid patients without access to the necessary treatment they deserve,” said Nancy Egerton, pharmacy manager, NYOH. “As medical professionals we pride ourselves on helping our patients through an extremely difficult time in their life. We should have the state’s support and assistance in caring for patients, not their bureaucratic interference.”

In response, NYOH has established the “Save Our Access, Save Our Access” campaign to rally advocates and the concerned public to demand Governor Hochul and the Department of Health to reverse this policy change and restore access.

Before this policy change, Medicaid patients had been able to have their prescriptions conveniently filled on-site at physician dispensary. This allowed patients to submit their script to the pharmacist overseeing the dispensary and receive their medication right there. Standard pharmacies aren’t always stocked with the caliber of medication needed for most patients undergoing treatment, so by utilizing a physician dispensary, patients have quicker and easier access to their medication. In addition, this allows for direct one-on-one patient education. Which could include enrollment in patient assistance programs to help decrease out-of-pocket expenses.

“It is imperative that the Department of Health overturn this inefficient policy,” said Michael Reff, executive director for the National Community Oncology Dispensing Association (NCODA). “The state is sending a clear message, if you are enrolled in Medicaid, you won’t have access to life saving cancer medications. However, if your insurance is through another provider, then these resources can be available to you. Accessible health care, especially cancer care, should be for all New Yorkers not just some.”

Medicaid patients that are battling their cancer illness are now forced to obtain their oral cancer drugs through Pharmacy Benefits Manger (PBM)-owned mail-order pharmacies. This process can put people in confusing situations that can result in signature delays, denials and higher costs.

PBMs serve as the middlemen between insurance companies, pharmacies and drug manufacturers. PBMs are responsible for negotiating lower drug costs with pharmacies and drug manufacturers so that the cost savings benefit the insured and insurance companies. With growing concern about how much of the cost savings is provided to the patient versus how much of the savings goes to the insurance company, New York State recently passed strict PBM legislation requiring PBM registration and established PBM oversight by the New York State Department of Financial Services (DFS). This agency is now responsible for regulating PBMs to ensure they act fairly and don’t shift all the cost savings to insurance providers. NYOH was at the forefront of and is supportive of PBM legislation and looks forward to working with DFS to ensure a more affordable and accessible health care system for all our patients.

For more information about the Save Our Access, Save Our Lives New York rally, please visit saveouraccessny.org.

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About New York Oncology Hematology: New York Oncology Hematology (NYOH) is the leading provider of community-based cancer care and blood disorder services. With six convenient locations in Albany, Amsterdam, Clifton Park in Saratoga County, Hudson and Troy, our team of 34 physicians and more than 350 cancer care specialists see more than 100,000 cancer visits a year. newyorkoncology.com.

About Save Our Access, Save Our Lives NY: The Save Our Access, Save Our Lives NY campaign is in response to the New York State Department of Health’s (NYSDOH) policy change that adversely affects how Medicaid patients access their cancer medication. This initiative is to not only bring awareness to this detrimental policy, but demand that NYSDOH and state officials overturn this policy so that cancer patients can receive the necessary medication they deserve. saveouraccessny.org.