First Health/Provider Synergies, the PBM used by the Quaker State to manage most of its Medicaid formulary decisions, has adopted a draconian new procedure that will make it almost impossible for Medicaid-eligible Pennsylvanians to get any new, cutting-edge medicines.
Astonishingly, FH/PS will give each pharmaceutical innovator one hour per year to make clinical presentations on all their products and one additional hour per year for "continuing education" on their products. This is not one hour per product; this is one hour per company!
This is a staggering demonstration of disinterest in clinical information, further demonstrating Medicaidâ€™s broken process for choosing medicines -- more akin to a rug bazaar than proper science.
And it negatively impacts Pennsylvaniaâ€™s neediest population. In a private plan, the consumer can make a choice to accept a higher co-pay for the medicines their doctor deem best for their condition. Medicaid recipients cannot. Typically, a prior authorization enforced by FH/PS makes it impossible for Medicaid recipients to get the medicine their doctors want them to have.
When cost-savings are put ahead of patient health, itâ€™s not only bad process, itâ€™s bad medicine.