Washington State Plans Attempt to Limit Brand-Name Drugs for Medicaid Clients

A Washington state plan to reduce Medicaid costs is receiving a worried reaction from doctors, patient advocates and some in the drug industry. Modeled on a Florida program that limits brand name drug prescriptions to four per Medicaid patient, the Washington plan was introduced on Friday and is set to take effect in January.

The program employs an out-of-state pharmacy consultant to review with doctors any patient's drug history that calls for prescription of more than four brand-name medications. If possible, the consultant would suggest cheaper alternatives. The doctor would have the final say.

"The proposed rule has the potential of causing harm and confusion among patients and exhaustive bureaucracy for pharmacists and providers," Joel Hastings, Lifelong AIDS Alliance government affairs director, wrote to Gov. Gary Locke in a letter also signed by advocates for people with asthma, Parkinson's disease, mental illness, arthritis, epilepsy and heart disease.

Several categories of drugs would be exempt from the count, however, including medications for HIV/AIDS and cancer, antidepressants and antipsychotics, and contraceptives. But this has prompted some groups to cry foul and indicate that the new rule will set up a "divide and conquer" move, since it does not make drug limits for all diseases. "We are definitely going to file a complaint with the Attorney General's office under the Americans with Disabilities Act," said Skip Dreps of the Northwest Chapter of the Paralyzed Veterans of America.

"We are on a collision course," said Thomas Bedell, acting assistant secretary of the state's Medical Assistance Administration. "There are going to be some harsh realities." Drugs cost the state Medicaid program more than $400 million a year. Health-related expenses account for 55 percent of the state's budget growth. With the downturn in the economy, the Department of Social and Health Services (DSHS) is looking at major budget cuts. Prescription drugs are an obvious target.

The "Therapeutic Consultation Service" will apply to about 437,000 Medicaid fee-for-service patients in Washington. Of those patients, between 15,000 and 17,000 take more than five prescription drugs per month.

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