ANNAPOLIS – With Maryland facing a $1.7 billion deficit, state health officials are trying to encourage doctors to use lower-cost medications to save the state $8 million.
If the preferred prescription drug program is created, the state’s Medicaid doctors will have to choose from a list of generic drugs instead of prescribing more expensive brand-name drugs to their patients.
The Maryland Department of Health and Mental Hygiene and the General Assembly support instituting such a list to cut the cost of Medicaid. Legislation to implement the program passed both the House and Senate this year, but it failed to win final approval before the end of the session.
The proposed drug list will affect about 120,000 people who receive fee- for-service care, according to the health department.
“If the program is not implemented, then there will be additional pressure on the state budget and the state will have to cut spending from somewhere,” said David Romans, budget analyst for the Maryland Department of Legislative Services.
Medicaid is a joint federal and state program that serves low-income individuals who cannot afford health care.
The cost of the program will increase 7 to 8 percent each year for the next five years, while the general revenue fund will only increase about 4 percent, according to the Maryland Department of Legislative Services.
“Medicaid accounts for about 15 percent of the state budget,” said Romans.
Some advocacy groups, including the newly formed Maryland Health Advocacy Alliance and the Maryland chapter of the Arthritis Foundation, say the list will limit access to drugs and interfere with the doctor-patient relationship.
A poll of Maryland voters revealed that 77 percent oppose the required authorization before a doctor can prescribe medication not on the list according to Gonzales/Arscott Research & Communication.
The poll was taken before the state deficit estimates jumped from $1.3 billion to $1.7 billion.
“I think the poll shows there is still a strong doctor-patient relationship, but in the face of a $1.7 billion dollar deficit the debate is going to be very different,” said Carol Arscott of Gonzales/Arscott.
Under the proposed program, a doctor who wants to prescribe a drug that does not appear on the list may call a 24-hour hotline and the Department of Health must respond within 24 hours. During the wait, physicians may prescribe a 72-hour emergency prescription.
Drugs used to treat HIV and anti-psychotic drugs will be exempt.
“Consumers will have access to all drugs,” said Debbie Chang, secretary of Health Care Financing at DHMH.
“Our concern is that all drugs are clinically effective and if the drugs are clinically equal, then we will encourage doctors to go with the less expensive drug,” said Chang.
Monumental City Medical Society, a Baltimore-based, African-American physician association, said that choosing drugs based on their effectiveness is not the real motivation of the Health Department.
“The process of determining this (clinical effectiveness) appears to be based primarily on cost. The result of such policy could be the selection of older, less-advanced medicine,” the group said in a statement released Tuesday.
The Health Department said access to drugs will not be limited and the system will work effectively.
“There is no reason we should be paying for the expensive drug when the less expensive drug is the same thing,” said John Folkemer, executive director of the Office of Planning and Finance in DHMH.
“For an overwhelming number of people, generic drugs will have the same effect as brand name, but for some people it will not work and the brand-name prescription can be prescribed.”
Locally and nationally, senior citizens find it difficult to keep up with the rising cost of prescription drugs, and are, perhaps, the population most concerned with this program.
“Senior citizens are large users of the state medical program and our members are very concerned with prescription drugs,” said Donna DeLeno, advocacy representative for AARP.
“In general, AARP is concerned with consumer protection, and as long as the impact isn’t negative, I don’t think this will be an issue,” she said.
The Health Department said the public would have ample opportunity to express concerns before the program can even begin, said Folkemer. “It is the department’s intent to get public comment,” Chang said. “If it was approved it wouldn’t be effective until 2003.” – 30 – CNS-11-15-02