Tuesday, April 25, 2006

Proviso could save medicaid millions! it was tabled

I introduced this proviso, yet it was tabled with only 8 members with me. -As a pharmacist, I witness wasted taxpayer money on prescription drugs on a daily basis. I would like to apply my 20 years of experience in pharmacy to offer solutions to the ever-climbing healthcare costs in the Palmetto State. Currently, Medicaid has a process called prior authorization or PA. This process is applied to some medications. In these situations, generic alternatives must be used first, and in the instance that the generic drug does not work; the more expensive medication may be dispensed. In no way is quality of care in jeopardy. If a consumer is paying cash for a product, naturally, they will try the least expensive option first. When the taxpayer is required to pay for medications covered by Medicaid, I believe we should take the same approach.

Prior Authorization is applied to many life threatening therapeutic classes with little or no problems, yet with exponential savings of the taxpayers' money. We apply the PA's to medications treating diabetes, blood pressure, esophageal reflux, and many, many more. Medicaid has 3 therapeutic classes that are exempt from prior authorization: HIV, Oncology (cancer), and mental health.My amendment removes these classes from exemption. I doubt if we'll see much money saved on oncology or HIV drugs in the near future, yet I am confident that there is much room for savings in the mental health area. Also, we spent $600 million on mental health drugs in 2005 on Medicaid. Two drugs Risperdal & Zyprexa cost us $49 million.

For example, Zyprexa can cost up to $1200 per month. If Zyprexa was placed on PA, a generic alternative such as haloperidol may be used. Haloperidol costs less than a $100 per month. If the patient does not tolerate haloperidol, then Zyprexa may be dispensed. This process would not be applied to a patient on a maintenance regimen with stable results, only new diagnoses.

This proviso does not place any medication on Prior Authorization; it allows Medicaid more options. The Pharmacy and Therapeutics Committee makes these determinations. Here's a link to their website: http://www.dhhs.state.sc.us/dhhsnew/PATCouncil.asp

We don't have an unlimited amount of funds for our Medicaid recipients and I am confident that this proviso will free up scarce Medicaid dollars for areas of need.