One-Pager Opposing HB 1283: PDL not in Managed Care
The Basics: Under Medicaid, certain drugs are chosen as “preferred.” That list is called the preferred drug list (PDL) and Medicaid rules force patients onto these specific drugs. Prior Authorization Headache: If a doctor wants a patient to be on a different drug, that requires a prior authorization which can be cumbersome and leads to delays and denials of care. This happens often in Medicaid and it is a burden for doctors and patients.
Starting in September, managed care is set to control the formulary. At that time, Medicaid patients will have more predictable drug coverage, like the rest of Texans. That is—unless the state passes HB 1283.
The Problem: Under the state’s management, the formulary switches based on the amount of rebates they can get on a drug. This “rebate chasing” means patients have to switch off drugs they are stable on (non-medical switching) or doctors, pharmacists, patients, and managed care plans have to go through an onerous prior authorization process.
See the full one-pager.