Physician Lawsuit Alleges Massachusetts Medicaid’s Prior Authorization Policy Harms Beneficiaries’ Mental Health Care

Boston psychiatrist Dr. George Sigel has filed a lawsuit in a state court alleging that the Massachusetts Medicaid program's policy of requiring prior authorization for some psychiatric drugs impedes beneficiaries' quality of care, the Boston Herald reports. The policy requires prior authorization for certain antipsychotic drugs, some antidepressants and for drugs used to treat conditions for which they are not specifically approved. Under the policy, beneficiaries who have been successfully taking treatments may no longer be able to obtain drugs, the suit maintains that they could "regress, break down or become unstable to function." In addition, the suit states that requiring prior authorization for off-label use of anticonvulsant medications harms beneficiaries' care. The Herald reports that state Medicaid officials already made one policy change sought by the suit. According to Paul Jeffrey, director of pharmacy for Medicaid, officials recently lifted the requirement for prior authorization for antipsychotic drugs to treat bipolar disorder and schizophrenia prescribed at doses higher than those approved by the FDA. Officials from the state's Division of Medical Assistance, which administers Medicaid, defended the prior authorization policy, saying that beneficiaries can appeal authorization decisions and continue receiving their treatments during the 30-day appeal process. However, Sigel said that if the appeal is denied, beneficiaries could be billed retroactively for the drugs. The court recently denied a preliminary injunction, which would have suspended the policy while the case is heard, the Herald reports (Lasalandra, Boston Herald, 9/23).