Constituencies take on access to care, prescription limitations
Physicians attending the National Conference of Special Constituencies April 29 - May 1 issued a rallying cry against some entities' efforts to curb the cost of Medicaid by limiting the number of doctor visits allowed to Medicaid patients and the number of prescriptions provided to those patients.
The new physicians' constituency passed a resolution asking the Academy to "support medical necessity rather than insurance carriers or health care systems dictating frequency of patient visits." The resolution aims to ward off potential denial of service to patients who exceed visit limitations and the cascade of complications that could follow. For example, attendees said, regulators may expect physicians to provide free care for patients who exceed their visit limits, and physicians may become liable for poor outcomes that -- due to limited access to patients -- the physicians could not address.
Two resolutions approved by all of the constituency groups call on the Academy to oppose "term determination" of prescriptions by individuals or organizations that have no prescriptive authority and to oppose third-party payers' limitations on the number of prescriptions considered a covered benefit for individual patients.
The two resolutions were prompted by a trend in which government, insurance companies and health care providers have moved to control cost by limiting beneficiaries' doctor visits and prescriptions. Though most apparent among Medicaid patients, the trend also has affected people with private insurance, said attendees.
All of the constituency groups also passed a resolution asking the Academy to work vigorously to make prescription drugs more affordable. "Patient assistance programs are getting more and more restrictive as (pharmaceutical) companies merge," said Susan Kinast-Porter, M.D., of Monroe, Wis.
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