Medicaid, Pharmacies and Unintended Pregnancy


This week I saw my third patient with an unintended pregnancy as a result of New York State’s new Medicaid formularies.  New York State recently gave over its widespread coverage of medications for Medicaid recipients to the managed care Medicaid plans, allowing their more restrictive formularies to decide which medications are covered, which aren’t, and which ones require “prior approval.”  In the ensuing chaos, many women find themselves at the pharmacy trying to refill their contraceptives and being told “your insurance doesn’t cover that anymore.”


Take, for example, 19-year-old community college student, Ayesha, who was using the ring.  It turns out her insurance does still cover ring, but she needed to get a prior authorization from me.  Sadly, her pharmacy didn’t explain that to her, and even if they had, she would have needed to call the my health center, get a message to me, we then get a form from her medicaid managed care plan, fill it out, get the approval, get the information to the pharmacy.  In other words, too many steps, too many days of delay during which she is not using birth control.  And for a young woman who is working and going to school and juggling a one-year-old already, these barriers are too much.  So, today Ayesha came in for a pregnancy test and it was positive.  She wasn’t ambivalent about what she needed, she wanted an abortion and then an IUD.  But it’s more than she should have had to go through.

This change in the New York’s Medicaid pharmacy benefits has created another layer of bureaucracy in health care. It is supposed to save taxpayers money but meanwhile who pays?  Women like Ayesha who cannot afford to go through additional hoops to get to their medications.

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