DETROIT - The National Urban Indian Coalition has joined an appeal of a U.S. District Court decision that it feels is hurting American Indian Medicaid patients in Michigan, and may be setting a bad precedent that can be applied to Natives in other states.
At issue are more stringent Michigan rules (called the Best Practices Initiative) that make it harder to get some prescription drugs without prior approval from the state. The net effect, according to NUIC, is to deny Indians medications that used to be available to them under Medicaid, and to divert scarce financial assistance from urban Indian centers like American Indian Services Inc. here to help Indians buy their drugs.
Earlier this year NUIC joined a suit brought by the Pharmaceutical Research and Manufacturers of America and the National Alliance for the Mentally Ill against Tommy Thompson, secretary of the Federal Health and Human Services Department, that sought to have the Michigan rule overturned.
However, the U.S. District Court of Appeals for the District of Columbia in March upheld Michigan's and the Secretary's position, saying they "withstand statutory and constitutional challenge."
Now, the three groups are appealing that decision. Oral arguments in the case were set for Washington, D.C. on Dec. 12.
According to NUIC Vice President Patricia Newada, "In late February 2002, Michigan began to implement a new program to limit the access of certain prescription drugs that previously were generally available to Medicaid recipients. Since this program was implemented, we have noticed a substantial increase in the number of cases in which American Indians did not get the medications they needed."
Newada said many of the nation's 2.6 million urban Indians rely on Medicaid, and that "we are deeply concerned that limits on access to medicines in the Medicaid program will create dangerous situations for urban American Indians who require the Medicaid program to survive."
Fay Givens, executive director of American Indian Services, testified in court papers that she has seen a "substantial" increase in clients seeking financial assistance to pay for Medicaid drugs since the new rule went into effect.
"AIS provides the requested assistance with monies from its restricted funds, thus diverting monies that would otherwise be allocated towards providing food, transportation, housing and other assistance. If the initiative is allowed to continue, AIS claims, the provision of prescription medication will ultimately crowd out AIS's provision of other services for urban Indians," according to the District Court's decision.
According to the court, "under the (Michigan) initiative, unless drug manufacturers provide Michigan with rebates on drugs prescribed through Michigan's Medicaid programs (and two non-Medicaid programs) that are greater than the rebates ordinarily required under the Secretary's national Medicaid agreement, (Michigan) may require that doctors prescribing the manufacturers' drugs to Medicaid patients must seek prior authorization from the state."
The three groups charge that Medicaid patients are being "relegate(d) to second-class status" by the state's requirement "that Medicaid physicians prescribe in accordance with state mandates, rather than their own discretion, or face a daunting labyrinth of state review in pursuit of their medical judgment."
This conflicts with a federal "mandate that Medicaid patients have the same access to federally-rebated drugs as non-Medicaid patients."
NUIC gave three cases of Indians being hurt by the new regulation. In one, a Cherokee woman subject to seizures suffered seizures when forced to change meds to a drug on the state's "formulary." One of the seizures occurred right in the pharmacy, "when she was told her medications would not be covered."
Another, a man of Chippewa descent, suffered a delay in getting ulcer and blood pressure medications, a delay that could have proved fatal. A third, of Mohawk and Kahnawake descent, suffers from depression and other ailments, and becomes anxiety-ridden each time she must get medicine because she fears getting them will be a lengthy and involved process.
NUIC's Newada said "these problems can be particularly acute when the individual is in danger of being denied psychotropic drugs that the patient has been accustomed to taking. Many times medications have not been tested on American Indians, and an Indian patient has difficulty finding a medication he or she can metabolize, it often takes a long and laborious effort to find a medication that works without the side effects."