State moves to limit Medicaid drugs

Proposal to list preferred prescriptions to save money stirs opposition

November 15, 2002|By M. William Salganik | M. William Salganik,SUN STAFF

The state health department is launching an effort to save money by issuing a list of preferred prescription drugs for Medicaid beneficiaries, and opposition to the plan began to surface this week.

Dr. Georges Benjamin, state health secretary, said the plan "may be a little inconvenient" but would result in substantial savings without harming patients. He said he thought fears about the plan had been stirred by "the drug companies, who are really pushing" opposition.

An official of Maryland Health Advocacy Alliance, a new group that criticized the plan this week, conceded it had received "seed money" from two large drug companies, but leaders said the group opposed the plan because it would restrict patients' access to needed medications.

The concept was also debated by the General Assembly this spring. The House and Senate passed separate bills approving it but didn't reconcile the versions before adjourning. Three legislative leaders - Casper R. Taylor Jr., House speaker; Barbara A. Hoffman, chairman of the Senate Budget and Taxation Committee; and Howard P. Rawlings, chairman of the House Appropriations Committee - wrote to Benjamin asking him to implement a prescription list administratively rather than through legislation. Benjamin announced this month he would do so.

Such a list could be "extremely restrictive" and "eliminate some of the newer, more expensive" medications, said Marilyn Edmunds, executive director of the new health advocacy alliance.

Health department officials, however, said Medicaid enrollees could get prescriptions not on the list if a doctor documented a need. If a disagreement between the doctor and the state as to need arose, there could be an appeal, and the patient could get a 72-hour supply.

Debbie I. Chang, deputy health secretary, said the list - which would be implemented the middle of next year, after the health department receives comment - would apply to about 120,000 patients in nursing homes or otherwise eligible for both Medicare and Medicaid. That's about 20 percent of those in the state's Medicaid program; the rest, low- and moderate-income children and welfare mothers, are enrolled in HMOs, which already have drug lists, called formularies.

The list would save about $20 million a year, from a Medicaid drug bill of more than $300 million. The savings would come from rebates from manufacturers whose drugs are on the list and from the use of less expensive drugs. For example, Chang said, Zantac, a popular ulcer medication, costs $1.71 per pill, but an equivalent generic version is available for 10 cents.

While the alliance opposes the plan, some groups support it. Donna DeLeno, advocacy representative for AARP-Maryland, said, "In light of the state budget, we want our Medicaid dollars to be used wisely."

Kirsten Thompson, who operates a consulting firm called KDT Public Affairs and said she is a member of the alliance steering committee, said the alliance had received "seed money" from two drug manufacturers, Pfizer Inc. and Glaxo- SmithKline. She said she was not sure how much money had been received.

Jan Thompson, president of the Maryland Chapter of the Arthritis Foundation, one of the groups supporting the alliance, said participating groups were made aware of the funding source.

She said her association "wants to stand on the side of letting patients get what their doctor thinks is best." As for drug company funding, she said, "We wouldn't be able to form an alliance if we didn't have the funding."

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