Florida Medicaid Beneficiaries Sue State Over Denials of Prescription Drugs

Five Florida Medicaid beneficiaries and an organ transplant recipients' group filed a federal lawsuit on March 28 against the state's Medicaid program, alleging that a new formulary program has resulted in illegal denial of prescription drugs, the South Florida Sun-Sentinel reports. Under the state's program, adopted to help reduce drug spending, doctors can only prescribe medicines to Medicaid beneficiaries from a preferred drug formulary, and patients can only obtain four brand-name drugs at a time. Doctors can request authorization from the state to waive these restrictions. The suit, filed in federal district court in Miami, does not challenge the restrictions themselves, but that claims Medicaid beneficiaries should get "advance warning and the chance to appeal before the state cuts off their drugs." Miriam Harmatz, a Legal Aid attorney who filed the suits on behalf of the five beneficiaries and the Florida Transplant Survivors Coalition, said, "These people have been cut off from the medicines they need, without any notice and without any recourse." The suit, which seeks class-action status, cites a study finding that more than 150,000 prescriptions within a six-month period were denied for exceeding the four-drug limit. Doctors requested exemptions in 40% of these cases. "Most of the time a generic is fine. But some people get hurt by the change and they are clueless about what to do," Harmatz said. Bruce Congleton, a spokesperson for the Florida Agency for Health Care Administration, which administers Medicaid, said the agency had not seen the suit and declined to comment (LaMendola, South Florida Sun-Sentinel, 3/29).