On July 10, 2005 major Medicaid changes mayaffect

your access to mental health medications

On May 26, 2005, Governor Bush approved significant legislative changes to Florida’s Medicaid services

that may affect your access to mental health medications.  Mental health medications are now included on

the state’s Preferred Drug List (PDL) meaning that only medications approved by the state can be accessed without prior authorization by state Medicaid officials.  In addition, one of the more troubling changes is a

new regulation that requires consumers to take medications from the PDL before they can access a

non PDL medication.

How will this affect mental health consumers?

• Beginning July 10th, if your current mental health medication is not on the state’s list of preferred medications, you may be required to switch to a medication that is on the list.

• Should the cheapest medication fail, you will then have the opportunity to try the second cheapest medication and so on until finding a more expensive medication that works.

• Only after that medication has proven to fail will your doctor be able to prescribe you a new medication not on the preferred medication list.

• If you are affected by these new guidelines, you may have to go through this fail first process every year.

What Should You Do?  

Step One:       Talk with your Doctor

Some questions to ask your doctor include:

• Which of my medications are not on the list of preferred medications?

• How will changes to my medication affect my treatment?

• How are the side effects of the other medications different from my current prescription?

• How can we work together to ensure that I have access to the best treatment?

Step Two:       Seek a Prior Authorization Request from Your Doctor

• Ask your doctor whether they can write an exemption letter stating the medical necessity of your medication?

• Confirm that your prescription will continue during any authorization process.

• Request written notification of all decisions

• If your exemption is denied, find out how to appeal the decision.

Step Three:    Look into Alternate Plans

There are a number of prescription assistance programs that may be able to help you stay on your current medication. One such program is the Partnership for Prescription Assistance (1-888-4PPA-NOW  www.pparx.org).

Step Four:      Regional Office: 1-800-226-2316

Consumer Resources