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APHA Scientific Session and Event Listing

Recorded presentation

Gene Bishop, MD, Pennsylvania Health Law Project, 400 Chestnut St. Suite 900, Philadelphia, PA 19119, 1-800-274-3258, sprucedoc@verizon.net

The rising cost of medications has led commercial and government payors to utilize preferred drug lists and pharmaceutical cost management tools. These measures have been criticized or actively opposed by diverse constituencies: consumer advocacy organizations worried about adverse effects on their members, physicians objecting to loss of control of patient care decisions and pharmacists frustrated with administrative burdens and loss of ability to utilize their expertise. Although these groups should share a common interest in improved use of pharmaceuticals, the one-on-one nature of patient/doctor interactions and patient/pharmacist interactions favors viewing pharmaceutical access problems as individual “glitches” rather than systemic problems. A collaboration between a physician and a healthlaw legal services organization utilized calls to a statewide legal services helpline to identify problems in access to pharmaceuticals under Medicaid managed care, and converted the frustration of physicians and pharmacists into positive action by connecting them and their patients to the services of the helpline. These connections revealed the commonalty of problems faced by the user groups, and their systemic basis. Consumer representatives to the state Medical Assistance Advisory Committee then utilized the collected data to address state oversight of Medicaid managed care pharmaceutical operations leading to improved access for beneficiaries and fewer administrative hurdles for providers. Key to this effort was 1) linking physicians and pharmacists to the legal services resources, 2) appealing to physician professionalism by transforming anger into patient advocacy and 3) adding clinical knowledge to legal services representational efforts.

Learning Objectives: