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Medicaid drug restrictions could hurt New Yorkers

When you want advice, you go to an expert. What movie to see this weekend? Read the film reviews. What's that funny noise in the car? Make an appointment with the mechanic. What's the best treatment for your medical condition? Go see your doctor.

But doctors' expertise may not matter when it comes to their ability to prescribe you the medication they feel is best for your health -- at least not if you live in New York State and require a medication that falls outside of what the state decides to protect in Medicaid. As a pain patient and founder of the U.S. Pain Foundation, I have serious concerns about the soon-to-be released list of prescription drug formularies from the New York State Department of Health.

Under Gov. Andrew M. Cuomo's direction, the Medicaid Redesign Team has moved the state's Medicaid prescription drug plan into managed care. As part of this revamped plan, only medications deemed appropriate by the managed care plan, and not the patient's doctor, will be available to residents on Medicaid as of Oct. 1. The expertise of a patient's physician has been minimized, patient health will be at risk, and long-term costs can be expected to rise.

After surviving an accident at work in 2003, I live with pain every day. Medication that my doctor and I have deemed most effective helps me get through the day. And I am no different from the millions of other pain sufferers out there. When we go on a trip, we can't focus on our destination; only on not forgetting our medication. Living without it is terrifying to us.

Imagine the thought of not having access to the medication you need for a long period of time, or worse -- not at all. But that is what we may be faced with in New York. The number of drugs that may not be available to millions of New Yorkers is staggering, and this doesn't simply affect one disease group; these cuts have an enormous reach.

Pain patients, those living with HIV/AIDS, those who suffer from mental health issues, organ transplant recipients, and those living with auto-immune diseases like Lupus all could be in jeopardy of not having access to medications that are critical to their lives.

Study after study shows that when barriers to medications are put in place, adherence rates plummet. What does that mean to the rest of the taxpayers in New York State? It means an increase in costs for hospital and emergency room visits for these same patients who would remain healthy if on the proper medication.

We all understand the need to cut the budget and save money in these tough economic times. But, doing so on the backs of New York taxpayers who are the sickest among us is not the way to achieve fiscal health. And surely taking medical decisions away from medical experts -- doctors -- is no way to make New York residents healthy, either.

Paul Gileno is president and founder of the U.S. Pain Foundation.

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