Medicaid patients sue D.C. over drug denials
  • Mon, 07/09/2012 - 4:22pm

Patients denied prescription drug coverage

Patients are accusing the District of Columbia of neglecting to explain denials of Medicaid coverage for prescription drugs, and as of June 8, the U.S. Court of Appeals for the District of Columbia has granted them the right to pursue the controversy in court.

According to, each state has a Medicaid program that provides lower-income people, families and children, the elderly and the disabled, with proper health coverage. The regulations for Medicaid differ from state to state, but most states provide coverage for families at some income level.

Plaintiffs stated that the D.C. Dept. of Health Care Finance is not telling them why patients are being denied prescription drug coverage. Medicaid patients have been repeatedly denied coverage, and according to American Medical News, the plaintiffs sued the district in 2010.

Until this suit, plaintiffs were unable to challenge the refusals and have unable to attain important medications.

The U.S. District Court for the District of Columbia denied the lawsuits because patients have not suffered any injury. Judges overruled this dismissal, claiming that the plaintiffs have in fact been harmed due to the refusal of necessary medications, therefore leading to future damage.

Refusal may be caused by doctor errors

In some cases, physicians may have ordered a prescription for a patient without knowing that approval from Medicaid was necessary prior to writing the prescription. If patients were made aware of these physician errors, they could contact the doctor’s office and gain Medicaid approval for the prescriptions.

According to American Medical News, court documents show that the district was not at fault for the majority of cases because pharmacy and physician errors were to blame.

Though patients have been denied drugs at the pharmacy counter, these delays were reported to have been resolved months before an objection was filed.

The central issue with this lawsuit is not necessarily that patients are being denied important prescription drugs, but rather that patients ought to have the right to know why they are being refused.

“The need to tell the patient what is happening is a basic right of people. If the government turns you down for something, you should know the reason for it,” said the patients’ attorney, Bruce J. Terris.


About the Contributor

Kaitlin Gill
I report on news regarding product safety concerns for individuals and families.

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