Despite legislative leaders' general inclination against one and votes as recently as August to end studying it, a preferred drug list keeps jumping to the front of the short line of options for cutting prescription drug costs for Utahns on Medicaid.

Dr. David Sundwall, executive director of the Utah Department of Health and a longtime proponent of a PDL in Utah, admitted Wednesday that he keeps "harping" on the idea simply because the benefits would be so great.

"It mystifies me why we don't have one of these for Medicaid," Sundwall told members of the Health and Human Services Interim Committee.

Medicaid, the joint state/federal health insurance for the poor and disabled, is the third-largest insurance plan in Utah. It is the largest portion of the state's budget outside education funding.

Drug coverage is the fastest-growing component of the Medicaid budget, rising by 18 percent in each of the past seven years. Lawmakers on Wednesday explored ways to contain those costs, such as bulk purchasing and multi-state consortiums.

Utah has explored joining a Maine-based purchasing pool, Sundwall said, which could save the state millions of dollars per year. State officials have also tentatively looked at importing drugs from other countries such as Canada and Ireland.

"We've been vigorous," he said. "We're trying to get savings."

But Sundwall spent most of his committee time promoting a PDL. They are designed to ensure that states, which buy in mass quantities for their Medicaid recipients, have authority to limit the choices of brands of the most commonly prescribed drugs, such as medications that reduce cholesterol, if research shows those on the list are effective. A general downward shift in drug prices would be expected.

A proposal to create a test program for just two types of drugs — cholesterol-lowering medication and acid reflux prescriptions — was killed by the Executive Appropriations Committee in August. Health officials have estimated the pilot program would save the state some $5 million annually.

Twenty-eight states have established PDLs, with many of them reporting large savings, Sundwall said. Vermont has reported annual savings of $1.9 million, while Missouri saves $37.8 million each year.

Rep. Steve Mascaro, R-West Jordan, on Wednesday passed out copies of a draft resolution affirming the authority of the Department of Health to implement a test PDL for the two drug groups and urging the department to do so.

Sundwall could establish the list without the blessing of the Legislature, Mascaro said, but the move could be politically unwise. Mascaro said his resolution, if passed, would be a way to send the message that although members of the Executive Appropriations Committee may not support the idea, the larger legislative body does.

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E-mail: awelling@desnews.com