Group Sues Over Florida Medicaid's Denial of Drugs
By Bob LaMendola, Health Writer
Originally published in the Sun-Sentinel, March 29, 2002
Five patients and an organ transplant recipients' group filed a federal lawsuit against Florida Medicaid on Thursday, saying the state has illegally denied them prescription drugs without proper notice or the right to a hearing.
The class-action suit filed in federal district court in Miami says Medicaid patients should get advance warning and the chance to appeal before the state cuts off their drugs. Often, the patients do not learn they are denied until they bring a prescription to the drugstore, the suit says.
"These people have been cut off from the medicines they need, without any notice and without any recourse," said Miriam Harmatz, a Legal Aid attorney in Miami who filed the suit.
The denials stem from steps Florida's $10 billion a year Medicaid program took in recent years to cut the cost of prescription drugs for its 1.9 million low-income recipients.
The state created a list of preferred drugs and restricted patients to four brand-name drugs at a time.
Doctors can ask Medicaid for an exception if patients need drugs not on the list or beyond the limit of four.
The suit does not challenge the cutbacks. But Harmatz said many patients need their federal rights to notice and hearings because doctors often do not ask for exceptions or get discouraged by bureaucracy.
"Most of the time a generic is fine. But some people get hurt by the change and they are clueless about what to do," Harmatz said.
A study done for Medicaid tallied more than 150,000 denials for exceeding the four-drug limit within a six-month period, the suit said. Only 40 percent of the doctors requested exceptions.
One of the five patients named in the suit is David Burgess of Coral Springs, who was disabled in a 1983 car crash that crushed his hips and damaged his legs and spine.
He got relief by taking nine pills daily of the new painkiller OxyContin. But the suit said Medicaid suddenly would pay for only four pills a day, and Burgess, with $560 a month income, cannot afford to stay out of pain.
Bruce Congleton, a spokesman for the Florida Agency for Health Care Administration, which runs Medicaid, said the agency had not seen the suit and would not comment.
Two other patients in the suit are from Miami, one from Fort Myers and one from Orlando. The other plaintiff, the Florida Transplant Survivors Coalition, is based in Boca Raton.
One of the Miami men was a liver transplant patient who was denied a drug for a fungus, even though it is the only one that works without interfering with his anti-rejection drugs. He began rejecting his liver and had to go in the hospital for two weeks in December.
