New York Medicaid Changes Restrict Access to Fibromyalgia and Other Medications

by Karen Lee Richards Patient Advocate

I just received a news release indicating that if you live in the state of New York and are on Medicaid, access to your medications may be restricted in less than a week.

As a part of Governor Andrew Cuomo's Medicaid Redesign plan, prescription benefits through Medicaid become part of the private managed care system on October 1. For nearly three million New York residents, that means the managed care plans have the ability to restrict the medications offered for residents enrolled in those plans and many medications will no longer be available to them.

For example, on October 1 Medicaid beneficiaries who suffer from fibromyalgia and are enrolled in FidelisCare will no longer have unrestricted access to medications like Cymbalta, Lyrica or Savella. Other health care plans are taking similarly restrictive approaches in what will be available for patients on October 1.

Global Healthy Living Foundation, a patient advocacy organization, is concerned that, due to a lack of outreach by the state and Medicaid's transition to the private sector, many patients may not be prepared to handle this new system.
They are offering tips to help residents prepare to navigate the process of managing their prescriptions.

Check now with your managed care plan:

Many of the 21 managed care plans that will administer medications to residents have posted updated information on their websites about what medications will be available.
Log in now to check if the medication you're currently taking will be covered after October 1st.
Many plans are sending letters, too, so carefully read anything you get from your managed care company.

Talk with your doctor:

It is imperative that patients and doctors have conversations before October 1st about any change that could occur to the medications a patient is currently taking.
If your medication is switched, your doctor needs to know to ensure there are no medical consequences or negative outcomes that could affect your health.

Don't be afraid to ask questions:

Call the managed care company assigned to you, call the New York State Department of Health at 800-541-2831.
If you live in New York City, or your city has 311 service, call it, too.

Check with local support groups:

Many patient advocacy organizations such as the Patient Advocate Foundation are working with people on Medicaid to help with this transition. They can be reached at 800-532-5274 or at Neighborhood community centers, hospitals and clinics can also help. Check with these organizations in your neighborhood to see what resources are available to you.

Tell GHLF when you are denied drugs or services:

One way to fix problems that will occur during this transition is to speak up. The Global Healthy Living Foundation has a privacy-enhanced website where people can list the drugs or services they were denied. GHLF will use this data to measure the success of the program and negotiate with the state and private insurers for better care. It is important to go to and click on "I've been denied" on the home page.


"NYS Medicaid Changes: Do You Know if Your Prescription Might Not Be Available to You on October 1st?" PRNewswire. September 27, 2011.

Karen Lee Richards
Meet Our Writer
Karen Lee Richards

Karen is the co-founder of the National Fibromyalgia Association. She writes for HealthCentral as a patient expert for Pain Management.