South Carolina Medicaid Program Drops Prior Approval Requirement for OxyContin Prescriptions

The South Carolina Department of Health and Human Services on Nov. 1 dropped "tight rules" that required doctors to obtain approval from the state prior to prescribing the painkiller OxyContin to Medicaid beneficiaries -- a policy that has reduced state Medicaid costs and the "potential for abuse" of the drug, the Columbia State reports (Columbia State, 11/2). The state DHHS decided to drop the prior approval requirement for OxyContin despite a mandated 4% across-the-board budget reduction that the state Budget and Control Board announced Oct. 31. The department plans to reduce pharmacist fees to $2.05 per prescription, a $2 reduction, and lower Medicaid reimbursement rates for nursing homes and primary care providers (Kaiser Daily Health Policy Report, 11/2). According to department estimates, the prior approval policy has saved the state $500,000 in Medicaid costs per month. Under the modified rules, doctors may prescribe OxyContin -- which in recent months has received publicity because of its growing abuse as a narcotic -- for Medicaid beneficiaries without prior approval "as long as his or her prescription does not exceed six tablets a day." According to the State, most patients take two tablets a day. The new guidelines "are identical" to a proposal offered by Dwight Drake, a Columbia, S.C., attorney who represents drug maker Purdue Pharma, which manufactures OxyContin. Drake, a friend of South Carolina Gov. Jim Hodges (D) and a former colleague of state DHHS Director Bill Prince, proposed the plan in an Aug. 20 letter as a compromise to "avoid litigation" between the state and Purdue Pharma, which opposed the prior approval requirement. In September, Prince admitted that he faced "significant political pressure" to modify the policy, but said last week that he based the decision on "practical, not political" concerns. Prince added that South Carolina will "change the policy back if it sees a new explosion of prescriptions" for OxyContin. The state has not dropped the prior approval requirement, first imposed in July, on seven other drugs (Bauerlein, Columbia State, 11/2).