Earlier this year, the State of Pennsylvania’s Department of Public Welfare (DPW) announced that it intended to implement a “preferred drug list” (PDL) for Medicaid recipients in the state, primarily as a cost-saving measure. Essentially, this list would limit enrollees to a select group of drugs, and would either bar or make difficult consumer’s ability to access drugs not on the list. PDLs for Medicaid are not new. Most states have either implemented one or are considering doing so, although there are indications the cost savings are not significant. However, while most states with PDLs have exempted several drug classes, including clotting factor, Pennsylvania has so far indicated that it would be the first to place limitations on these essential drugs.
The National Hemophilia Foundation (NHF) and its two Pennsylvania chapters have been working diligently to make the case to the state that this measure is inappropriate and could harm patients. Key points in meetings with DPW staff, legislators and the Pennsylvania Governor’s office have included:
- There are no generic clotting factor products
- Each product has a unique manufacturing process and formulation
- Different products work differently for each patient
- The decision on which product to use should belong to the physician, in consultation with the patient or guardian
- Preventing a person with a bleeding disorder from accessing appropriate treatment can result in serious medical consequences, including joint damage or even death
In the last two months, NHF and its Pennsylvania chapters have worked with an outside group to conduct a broad media campaign on this issue designed to influence decision-makers in Pennsylvania and the public in general. The campaign had resulted in significant coverage of the issue in newspapers and other media across the state.
The issue will come to a head on December 14th when Pennsylvania DPW’s Provider and Therapeutics Committee (P&T) reviews clotting factor as a class. In response to media inquiries, some DPW representatives have indicated that they may yet decide to include all available products on the list, but this decision will not be made until after the P&T review on the 14th.
NHF will continue to monitor and report on this developing situation, and will continue to work with the entire community to ensure that Medicaid recipients in Pennsylvania and all people with bleeding and clotting disorders have access to the full range of treatment and high quality care.