Louisiana House OKs Medicaid Restrictions; Missouri Considers Senior Drug Plan Creation

The following briefly summarizes recent government action on prescription drug policy in Louisiana and Missouri.

• Louisiana: The Louisiana House voted 101-0 in favor of a Senate-passed bill that would restrict the types of medications that Medicaid beneficiaries may obtain. Under SB 502, an advisory panel composed of physicians, pharmacists and Medicaid officials would develop a formulary for the state's Medicaid program. Physicians seeking to prescribe a drug not included in the formulary would have to receive state permission before the Medicaid beneficiary could obtain the prescription. The bill now returns to the Senate for approval of House changes (Baton Rouge Advocate, 5/31). In other state drug news, the Louisiana Board of Pharmacy is considering changing the prescription pad doctors use to allow them to check a box if brand-name drugs are "medically necessary," the Baton Rouge Advocate reports. The new form is a compromise between doctors and pharmacists over a state law concerning the use of brand name drugs. Under existing law, pharmacists are prohibited from dispensing generic substitutes for brand-name drugs. While the Board of Pharmacy has not enforced the law, a bill (HB 865) to allow generic substitutions unless doctors write "brand medically necessary" on the prescription was defeated in committee earlier this year after lobbying from "major drug companies." Consequently, the bill's sponsor, state Rep. Ronnie Johns (D) proposed changing the state's prescription pad to allow for generic substitutions. The change has been added to HB 865, which has been revived by the committee in a procedural move. The Advocate reports that with the inclusion of the new prescription pad, those originally against the bill have dropped their opposition, calling the pad "far superior" to having physicians write out instructions (Dyer, Baton Rouge Advocate, 5/28).
• Missouri: Lt. Gov. Joe Maxwell has been named to chair a task force charged with creating a prescription drug plan for seniors, the AP/St. Louis Post Dispatch reports. Created by Gov. Bob Holden (D), the task force will hold hearings around the state and develop a drug proposal. The task force will include both Republican and Democratic state lawmakers, as well as pharmacists and physicians. Holden has ordered the task force to present its proposal during a special session of the Legislature in September. Maxwell said, "I have no preconceived notion about what is the right solution. The only wrong solution is no answer. My goal is to deliver sound policy on this issue" (Bellamy, AP/St. Louis Post Dispatch, 5/29).

Maine Rx Op-Ed
In response to a court decision approving the Maine Rx program, which would allow Maine to negotiate lower drug prices for uninsured residents and to mandate price controls if unsuccessful, state Sen. John Nutting (D) wrote that Maine will "take the lead" in offering prescription drug coverage. In a letter to the Bangor Daily News, Nutting writes that the plan will allow the state to use Medicaid purchases as "leverage" when negotiating discount prices for the uninsured. The plan had been opposed by the Pharmaceutical Research and Manufacturers of America, which argued the plan would interfere with interstate commerce. Nutting, however, quotes the court's decision, saying the only "burden" on commerce by the plan is on the "profits of the individual manufacturers." Nutting continues, noting that if he succeeds in his upcoming Congressional bid, he will "introduce the Maine Rx plan at the national level." He concludes, "It stands to reason that if Maine, with its 1.2 million people, can negotiate better prescription drug prices, the federal government negotiating for all our citizens can do even better" (Nutting, Bangor Daily News, 5/29).