CLASS ACTION SETTLEMENT REACHED REGARDING MEDICAID WITHHOLDING OF PRESCRIPTION DRUG COVERAGE

Hernandez et al. v Medows, a class action law suit on behalf of Medicaid recipients whose prescription drug coverage was denied without notice or the opportunity to appeal, has been settled by the lawyers and the named parties. A copy of the settlement agreement is posted at the FLS web site, www.floridalegal.org. Notice to the class regarding the settlement, the opportunity to object and the May 22 fairness hearing is being published in local newspapers and posted in all Medicaid pharmacies as of April 28, 2003. While the Medicaid agency has a year after entry of a final order in which to implement the remedies, which includes establishment of an Ombudsman’s office, they have designated a temporary ombudsman to assist recipients with prescription denials.
If you are contacted by a Medicaid recipient who cannot get his/her prescription, please obtain the following information and send it to me by e mail:
1. Name of drug
2. Recipient's full name
3. D.O.B
4. Recipient's Medicaid I.D. number
5. Name of pharmacy where rejection occurred
6. Address and phone of Pharmacy
7. Reason for rejection, if known.
Under the terms of the settlement, I will then forward that information to the temporary ombudsman and a response should be sent within 3 business days with the following:
1. Reason for rejection
2. Suggested self-help step(s) to correct the problem in the present or future, e.g. obtain prior authorization from physician
3. Actions taken by staff member
4. If applicable, a timetable for when the Recipient can expect to receive the requested drug.
Miriam Harmatz
Florida Legal Services
3000 Biscayne Blvd. Suite 450
Miami, FL 33137
305-573-0092
305-576-9664 Fax
miriam@floridalegal.org
www.floridalegal.org