State's preferred Rx list on hold

Following a public hearing in which most people said they do not want a state preferred drug list, the Legislature's top budget committee Tuesday told the Utah Health Department to put the controversial cost-cutting plan on hold.

The department still has the authority to move ahead. But Michael Deily, the state administrator of the Medicaid insurance program for the poor, said after the vote by the Executive Appropriations Committee that he will look at other alternatives to help save money.

"We'll continue to keep tabs on what other states are doing with their lists and will just have to review spending in other areas," Deily said.

The fastest-growing segment of Medicaid, which is the third-largest health plan in the state, is prescription drugs. The health department says more people are using more drugs, and at the same time new and more expensive drugs are replacing older ones.

The bulk of Medicaid expenditures go for the blind, the disabled, the elderly, and poor children. The cost per drug dispensed has risen to $54.77 from $41.09 since 2000. The state's portion of funding has increased to $48 million in 2003 from $29 million in 2000. At the same time, the number of people eligible for coverage has grown from 222,000 to 272,240, according to the health department.

Although some Medicaid clients, providers and area hospitals endorsed setting up cost controls such as prior authorization, use limits and more generic drugs, others said the idea is fraught with hidden costs and hang-ups, particularly for pharmacists. Not only would extra staff have to be hired to track prescriptions, the notion interferes with the patient/provider relationship, doctors and pharmacists told the committee.

Sen. John Valentine, R-Orem, said he wonders if pharmaceutical companies — which are blamed for the skyrocketing cost of health care, no matter what the plan — aren't themselves interfering with that relationship by telling consumers to ask their doctor if a certain drug is right for them, without giving an inkling of what the drug is for.

Mike Cobble, a local primary care physician, said doctors hate direct advertising, "but it creates awareness. It is a marketing tool, certainly, but ultimately the decision lies with the doctor."

Pharmacist Gordon Petersen said he has been trying to figure out who the preferred list is preferred by. "The patients don't like it, the doctors don't and pharmacists don't like it either," he said.

Petersen said when a patient under a private insurance plan comes in with a prescription for a medication not on their provider's preferred list, it can often take an hour to get a change approved by the insurance company.

The staff time involved handling those kinds of problems for Medicaid patients as well would overwhelm pharmacies, particularly the small rural ones that are already teetering on the edge financially, he said.

Deily reminded lawmakers that the department is nowhere near implementing the list. "And we would have no interest in creating a process so burdensome that the providers would drop out."

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