TPM Medicaid Due Process Case Highlighted by National Health Law Program

Senior Attorney at the National Health Law Program, Wayne Turner, highlights Maldonado v. District of Columbia in a recent article about prescription denials entitled, “When Patients Leave the Pharmacy Empty Handed.”  Maldonado v. District of Columbia is TPM’s putative class action case challenging the District of Columbia’s systemic failure to provide timely and adequate individualized written notice to persons whose prescriptions are denied Medicaid payment at the pharmacy.  In his post, Turner speaks to the human cost of this failure to provide notice, noting that up to forty seven percent of prescriptions submitted by Medicaid beneficiaries are denied coverage on any given day—a statistic that is compounded by the fact that low-income people who rely on Medicaid to pay for their prescribed medications often “have no other means of obtaining potentially life-saving medication.”

Turner explains how health law advocates, including TPM attorney Stephanie Madison and Sheldon Toubman of the New Haven Legal Assistance Association, are taking this issue beyond District lines and advocating for individualized notice on the national level. He notes that the National Council for Prescription Drug Programs was persuaded “to establish a Point of Sale Patient Specific Denial Notice Task Group” by Madison and Toubman who traveled to San Antonio to make their case for individualized notice standards. Along with organizations like the National Health Law Program, TPM continues to fight for the due process rights of Medicaid beneficiaries in the District of Columbia and beyond. Read Wayne Turner’s full article here.