Medicaid Advocacy Guide for Medical Professionals

As a medical professional, you have the opportunity to advocate for Medicaid patients in your state to have access to the full range of available treatments.

The National Psoriasis Foundation needs your partnership in a unique initiative to advocate at the state level for appropriate medical policies for the treatment of psoriasis and psoriatic arthritis. Patients encounter a number of barriers in Medicaid programs, such as:

  • Qualifying psoriasis patients for treatments based solely on Body Surface Area (BSA)
  • Requiring a patient to try and fail treatments not prescribed by the treating physician
  • Rationing the course and amount of treatment
  • Sequencing biologics by requiring failure of one biologic before another
  • Limited access to specialists
  • Limited availability of in-office phototherapy and/or lack of coverage for home UVB units

Medical professionals can and do make a difference when they advocate for the needs of patients

Dr. Kristina Callis Duffin, member of the NPF Medical Board and Assistant Professor at the University of Utah, presented information to educate and inform the Utah Drug Utilization Review Board about appropriate medical policies. Her advocacy resulted in significant improvements in patient access. Read her story »

Bring advocacy and awareness to your state Medicaid program

Help your state better manage the needs of low-income psoriasis patients by taking these easy steps:

1. Gather existing Medicaid policies

Gather all available information related to treatments available for psoriasis and psoriatic arthritis under the Medicaid program.  These can include prior authorization forms, formulary or Preferred Drug List (PDL) documents, and correspondence you have received from Medicaid, managed care plans, or specialty pharmacy.

  • Search the state Medicaid website for these items, if you do not already have them.

2. List issues with the policies

If you accept Medicaid and have difficulty in getting the right treatment for your patients, make a list of the problems you have encountered, or issues that you see with the policies. Note if the problems are connected to fee-for-service or managed care Medicaid coverage, as this may indicate the best route to resolution.

If you do not currently accept Medicaid, you can still make a difference for low-income psoriasis patients in your state. Review the policy documents you have gathered for areas of concern.

  • Download a detailed list of Issues and Barriers (pdf), which was provided to all 50 State Medicaid Directors

3. Write a letter to Medicaid director documenting the issues

Write a letter documenting your concerns and recommendations for policy change(s). Offer yourself as a resource to provide input from a clinician's perspective on the disease and available treatments. You would be surprised how often state Medicaid programs would welcome informed professionals as advisors!

Address the letter to your state Medicaid Director. Names and mailing addresses can be found on the NASMD website (mouse over NASMD Home, and select Members and you can download a Word document). Include a copy to the Pharmacy Director, and the Drug Utilization Review Board. Contact information can usually be found via the state agency website.

  • Use our template letter (Word) for an example to edit. Include your specific issues. The letter also references our May 24, 2010 outreach letter (pdf) to all state Medicaid directors, which you might also like to include.
  • Follow Dr. Callis Duffin's lead and make a presentation to the Drug Utilization Review (DUR) Board which evaluates criteria for drug coverage within the Medicaid program. Contact us for a copy of her slideshow to educate board members about the disease.

If you are having difficulty gaining access to your state Medicaid officials, contact your local state Representative or Senator and request the involvement of that office. You may also suggest this option to patients who are having a difficult time getting appropriate treatment under Medicaid.

4. Follow-up

We want to hear from you! Need help with any of the steps? Successfully advocated for change? Ready to share documents from your state Medicaid program? Contact the health policy manager at 800.723.9166 x423 or [email protected].

Resource: Our Medicaid advocacy tool kit has resources you can use to make your case »