Physician sues Massachusetts over prior authorization rule

As states struggle to control Medicaid prescription drug costs, doctors voice concerns about patient access to medically necessary treatments.

By Tanya Albert, AMNews staff. Oct. 27, 2003.

Concerned that he isn't able to give his Medicaid patients the care they are entitled to, Massachusetts psychiatrist George S. Sigel, MD, is suing the state over its prior authorization requirements for some prescriptions he writes.

Since May, Massachusetts Medicaid has required physicians to get prior approval from the state when they prescribe certain antidepressants and antipsychotics, including drugs that don't have FDA approval for the purpose for which they are being prescribed.

Although the state has relaxed some of the original requirements -- such as no longer requiring prior authorization when the dosage for a patient's antipsychotic prescription exceeds the FDA recommended amounts -- Dr. Sigel said the state is interfering with his duty to treat all of his patients the same.

"I am forced to discriminate in my practice," said Dr. Sigel, who filed the lawsuit on his own without any formal legal training. "When you come to someone like me, you hope I am going to make an objective assessment and give you the best treatment." Dr. Sigel and others in the mental health field say the program is also disrupting patient care.

"It is causing delays in patients getting their medication," said Bruce Mermelstein, a licensed psychologist who owns and operates Comprehensive Outpatient Services Inc., which has three locations in the Boston area. "And it's causing patients to get more upset and agitated, exacerbating their conditions."

A spokesman for the Massachusetts Office of Human Services declined to comment on the case because of the pending litigation. Phone calls to the Massachusetts Attorney General's office for copies of court documents outlining the state's position were not returned.