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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 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn