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Clinicians warn formulary limits are causing adverse outcomes for diabetics and people in recovery
Summary
Physicians and clinic directors told the Committee on Health that DHCF’s October formulary changes and prior-authorization burdens have prevented access to needed medications and treatments — from injectable diabetes medicines to Vivitrol for substance use treatment — and urged reverting to the previous formulary.
Multiple clinical witnesses at the Jan. 27 performance oversight hearing described steep clinical harms they attribute to changes in the Alliance formulary and medication authorization processes.
"Before the October 1 reductions, patients were getting the medicines they needed for their diabetes," said Dr. Kate Sugarman, a family physician at Unity Healthcare, adding that the administrative burdens for non‑generic medications and prior authorizations are producing adverse outcomes. She testified that some patients have lost vision and other complications because they cannot access specialty care and medications.
Carolyn Wakeman, a family physician at Mary's Center, described disruptions to addiction treatment after injectable naltrexone (Vivitrol) became unavailable under the revised formulary: "When she was receiving her monthly... she told providers that she was not having any cravings... and then in our October visit, we had to inform her that her Vivitrol was no longer covered." Wakeman and other clinicians urged DHCF to restore the prior formulary and the availability of medications that some patients depend on.
Policy advocates and provider groups also pressed DHCF to eliminate new formulary restrictions as a near‑term administrative change that could be implemented quickly if the contingency funding is provided. Witnesses characterized reversion of formulary changes as one of the most administratively feasible steps to reduce immediate harm while longer budget and eligibility questions are resolved.
