ANNAPOLIS -- The state of Maryland yesterday turned over the prescription drug program for its employees to an all-knowing computer network that can tell if someone is popping pills too fast, has been prescribed medicines that do not work well together or has filled the same prescription at another pharmacy across the street or across the country.
It can verify whether a customer is actually an eligible employee of the state, can identify patterns that could indicate prescription-drugfraud or abuse and can do it all before the across-the-counter transaction is actually made.
"Now, it is all done retrospectively, after the fact. We're not catching it at the point of sale," said Catherine K. Austin, 'N assistant secretary of personnel, referring to the old procedure. "Here, you can actually block a sale. This is state-of-the-art technology."
The new system might uncover illegal patterns involving prescription drugs that could lead to disqualification for the program, but the primary purpose is to educate prescription users, not to prosecute abusers, Ms. Austin said.
She and other state officials said that by hiring Pharmaceutical Card Systems of Scottsdale, Ariz., to administer Maryland's prescription-drug program over the next four years, the state could save at least $30 million through stricter prescription controls and lower drug costs. The company has a regional office in Vienna, Va.
Ms. Austin said Pharmaceutical Card Systems has computers in 97 percent of the state's pharmacies and operates a computer network in about 50,000 pharmacies nationwide.
The company will be paid $207.8 million to run the state program. Ofthe four bids for the contract, its was lowest. The bid from incumbent Blue Cross and Blue Shield of Maryland Inc., just under $210 million, was second-highest.
When the changeover occurs Jan. 1, Ms. Austin said, state employees also will be required to chip in more to keep the program running: $2 per employee each two-week pay period. Most employees now pay nothing extra for the drug program except a $5 co-pay fee each time they buy prescription drugs. That fee will remain unchanged.
Ms. Austin said the decision to levy the $2 fee was prompted primarily by the governor's directive to all departments to come up with ways to eliminate a state budget deficit that already exceeds $300 million, and by a desire to spread the cost of the drug program more equitably among those who benefit from it.
By the end of the year, the state intends to distribute to its 90,000 "primary enrollees" new Pharmaceutical Card Systems cards to replace the old Blue Cross cards. Counting the families of enrollees, the state prescription-drug program provides benefits for an estimated 250,000 people, Ms. Austin said.
Employees will use the new cards just as they did the old ones, presenting them and their $5 co-pay each time they need a prescription filled. What will be different is the readout that will appear on the pharmacist's computer screen -- a recap of the customer's prescription drug history as recorded in any Pharmaceutical Card Systems computer.
If a person has a prescription for a certain pill to be taken once a day for 30 days and shows up after 15 days for a refill, the computer will reject it, Ms. Austin said.
If a customer has a prescription for one drug and the computer determines that the same customer has recently bought a different prescription drug that interacts adversely with the first drug, it, too, will be rejected.
Retired state employees who live outside Maryland also will be helped by the new system, she said. Currently, a retiree who lives in Florida, for example, must pay for prescription drugs himself and then submit a paper claim for reimbursement. With the Pharmaceutical Card Systems system, the retiree in Florida would be able to buy the prescription the same way an active state employee living in Maryland would, she said.
Mark A. Levi, owner of the Medical Arts Pharmacy on Cathedral Street in Baltimore and immediate past president of the Maryland Pharmacists' Association, said, "PCS does the same thing [as Blue Cross] but arguably does it better than anybody else."
In turning to Pharmaceutical Card Systems, the state has decided to operate a "self-funded program" rather than an insured program such as the one with Blue Cross. That change alone should bring the state $8 million of the anticipated $30 million in savings, since a self-funded program does not have to factor in a risk margin, Ms. Austin said.
Additional savings will come from the requirement for pharmacists to dispense to Pharmaceutical Card Systems cardholders only drugs listed on that company's "drug formulary." The company independently enters into contractual relationships with pharmaceutical companies to buy drugs at a discount, and some of the savings are passed along to the state.
The contract with Pharmaceutical Card Systems guarantees a minimum savings of 30 cents per prescription or 40 percent of the discount savings that can be attributed to Maryland's participation in the program, whichever is higher.