Louisiana Lawmakers Try to Curb Medicaid Prescription Drug Spending

As the cost of buying prescription medications for individuals under Louisiana's Medicaid program is "rising at such a rapid rate" that it might exceed $900 million by 2005, a special state House committee met on Dec. 5 to discuss ways to combat the problem, the Baton Rouge Advocate reports. During the meeting, Department of Health and Hospitals Secretary David Hood said that Medicaid spending on prescription drugs is likely to hit $426 million this year and will exceed $500 million next year and called for "aggressive" steps to reduce expenditures. In Louisiana, prescription drug expenses have replaced nursing home care as the most costly Medicaid expense, the Advocate reports. To reduce some of these costs, Hood said he plans to ask the Legislature to allow his agency to require prior authorization before some prescriptions can be filled, a restriction that has not been successful in the past, the Advocate reports. Prior approval "gives an avenue (for a physician) to make a case that this particular drug for this particular patient is needed," Hood said. He added that he believes prior authorization is preferable to a "closed" drug list, which would limit what medications the Medicaid program will cover. But House Appropriations Committee Chair Luke LeBlanc (D) questioned whether prior approval would result in significant savings. Hood countered that savings would increase as the state became "more aggressive" in enforcing prior authorization. Drug company lobbyist Ken Ardoin said he opposes prior approval, adding, "It really should be left up to the physician and patient what's appropriate."

Other Measures
Lawmakers also examined other possible cost-cutting measures, including an incentive for Medicaid patients to choose generic drugs and a bulk purchasing plan. One lawmaker suggested that patients be charged copayments only for brand-name drugs, while another proposed the possibility of higher copayments for patients who demand a brand-name drug. To one lawmaker who suggested discounts for bulk purchasing, Ardoin replied that a drug company rebate program already gives the state the lowest price drugs for its Medicaid program (Shuler, Baton Rouge Advocate, 12/6).