FROM:
   The Associated Press State & Local Wire

October 27, 2001, Saturday, BC cycle
HEADLINE: State plans attempt to limit brand-name drugs for Medicaid
clients
BYLINE: By REBECCA COOK, Associated Press Writer
DATELINE: SEATAC

   Struggling with skyrocketing prescription drug costs, the state wants
to
start limiting the number of expensive, brand-name prescription drugs
used by
Medicaid patients.

   State officials introduced the program at a Friday forum, getting a
skeptical
and worried reaction from some doctors, patients' advocates and the drug
industry itself.

   The program is set to take effect in January. Here's how it would
work: when
a Medicaid patient is prescribed more than four brand-name medications, a
pharmacy consultant would review the patient's drug history with the
doctor. If
possible, the consultant would suggest cheaper alternatives. The doctor
would
still have the final say.

   Officials in Washington, and in Florida where the program began, say
they
need to cut costs and this program is a good, safe way to do it.

   "We are on a collision course," said Thomas Bedell, acting assistant
secretary of the state's Medical Assistance Administration. "There are
going to
be some harsh realities."

   The realities: drugs cost the state Medicaid program more than $400
million a
year. Health-related expenses account for 55 percent of the state's
budget
growth, according to the state Department of Social and Health Services.

   With the downturn in the economy and recent loss of Boeing jobs
affecting
state revenues, DSHS is looking at major budget cuts. Prescription drug
spending
is an obvious target.

   Officials estimate the "Therapeutic Consultation Service," as it's
called,
could save the state $20 million to $30 million a year.

   "You're talking about programs being eliminated because of $1 million
or $2
million," said DSHS pharmacy specialist Siri Childs. The four-drug limit,
she
said, "may make a difference."

   The limit isn't a hard limit, officials stress. An out-of-state
pharmacy
consultant would merely review the patient's drug list once it reached
five name
brands. The consultant would suggest other options, but the doctor's
decision
would be final. Pharmacies would also be allowed to dispense emergency
doses of
whatever drug was originally prescribed.

   Doctors worry that time spent dealing with a pharmacy consultant means
less
time to see patients and practice medicine.

   "It's the hassle factor," said Bob Perna, director of health care
economics
for the Washington State Medical Association. "It's one more
interruption, one
more brick in the wall."

   Patients' advocates fear that needed prescriptions will be denied or
changed
because of cost.

   "The proposed rule has the potential of causing harm and confusion
among
patients and exhaustive bureaucracy for pharmacists and providers," Joel
Hastings, Lifelong AIDS Alliance government affairs director, wrote to
Gov. Gary
Locke in a letter signed by advocates for people with asthma, Parkinson's
disease, mental illness, arthritis, epilepsy and heart disease.

   Several categories of drugs would be exempt from the count, including
medications for HIV and AIDS, cancer drugs, antidepressants and
antipsychotics,
and contraceptives.

   That's a "divide and conquer" move, complained Skip Dreps, government
relations director for the Northwest Chapter of the Paralyzed Veterans of
America. He said if the drug-limit policy is good for one disease, it
should be
good for all.

   "We are definitely going to file a complaint with the Attorney
General's
office under the Americans With Disabilities Act," Dreps said. "It's just
terrible. It's going to have some long-term consequences."

   Florida introduced the program one year ago, along with other
cost-saving
measures. Altogether the state has saved $260 million, said George
Kitchens with
Florida's Medicaid program.

   "The four-brand limit was a big part of it,' he said.

   The Florida program also exempts drugs for certain illnesses; Kitchens
said
that was because of political pressure from lobbying groups.

   But Washington state officials said their motive in excluding those
drugs is
medical, not political. There aren't alternatives for the drugs used by
those
groups, Childs said.

   The "Therapeutic Consultation Service" will apply to about 437,000
Medicaid
fee-for-service patients in Washington. Of those patients, between 15,000
and
17,000 take more than five prescription drugs per month, Childs said.

   Friday's forum included the head of Florida's health administration, a
Florida doctor who doesn't like the program, and a representative from
the drug
industry who opposes the program. Invitations were sent out to interested
parties, Bedell said - but not to any Medicaid clients.

   The state has scheduled a public hearing on the drug-limit program on
Nov. 6,
at 10 a.m., at the Blake Government Center in Lacey.

   On the Net:

   http://www.dshs.wa.gov

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