Washington Medicaid Program Plans to Limit Name-Brand Drug Use
To control "soaring" prescription drug costs, Washington's Medicaid program plans to push physicians to prescribe more generics by limiting beneficiaries to four brand-name drugs per month, the AP/Spokane Spokesman-Review reports. The Medicaid program's drug costs have almost doubled to $500 million over the past three years. Under the "Therapeutic Consultation Service" program, if a patient attempted to fill a fifth brand-name prescription in a month, the pharmacist would contact the physician, who would then have to contact a pharmacist hired by the state for approval. These pharmacists, who will be provided six days a week by Atlanta-based Consultec, will also examine the patient's current prescriptions to "prevent duplications and dangerous interactions." Siri Childs, a pharmacy research specialist with the state Department of Social and Health Services, said, "Our attempt is not to restrict drugs. It's to make sure patients are getting the right drug." Contraceptives, HIV medications, chemotherapy drugs, antidepressants and antipsychotics would be exempt from the four-drug limit. The program is slated to begin Jan. 1.
Physician, Drug Industry Resistance
The AP/Review reports that the state will need to "persuade" the medical community that the program will not only save money but will also "improve treatment." Dr. Nancy Auer, president of the Washington State Medical Association, said that the program would be "one more reason" for doctors to cut the number of Medicaid patients they treat, as Medicaid "already burden[s]" doctors with low reimbursements and "heavy paperwork." Cliff Webster, a lobbyist with the drug industry, said, "If you're denying people the drug they need, you run the risk of incurring even greater health costs for additional physician visits, hospital visits, emergency-room visits" (AP/Spokane Spokesman-Review, 10/2). The Medical Assistance Administration, which manages the Medicaid program, serves about 850,000 people and has a $6 billion budget (Preusch, New York Times, 10/2).
