Officials from Florida, Maine, Michigan, Pennsylvania and West Virginia will provide updates on their Medicaid and state employee prescription drug programs at a forum in Pittsburgh Friday (1/11).
Sponsored by the Northeast Legislative Association on Prescription Drug Pricesa group that has members from the New England states, New York and Pennsylvania, the meeting is hailed by organizers as a "true summit."
"It's unprecedented to get that many people together," says Cheryl Rivers, the group's executive director. Rivers, who hails from Vermont, resigned her state Senate post last fall to head up the association.
Medicaid is a federal-state program that pays for health services for poor, disabled and elderly people. It has traditionally put compassion before cost, but as states grapple with budget shortfalls, officials who run state pharmacy assistance programs under Medicaid are adopting tough-minded, businesslike approaches to rein in ever-escalating drug costs.
The new attitude is paying off. Maine saved $15 million last year by requiring doctors to get an okay before they prescribe certain drugs, a practice that's known as prior authorization, says Human Services Commissioner Kevin Concannon.
Drugs like Prilosec, a heartburn medication made by AstraZeneca, used to cost the state's Medicaid program $8 million a year. Now that figure is down to around $2 million, Concannon says.
"Unquestionably, this program worked and it's gone largely without a hitch," he says.
Elsewhere, states are applying the business concept for state employee's insurance programs. West Virginia's Tom Susman, who directs the Public Employees Insurance Agency , says he is tweaking pharmaceutical manufacturers' marketing practices to bring down the state's costs.
Drug companies typically give doctors free samples of medications for promotional purposes, which are then passed on to patients free-of-charge. The state can't hand out free drugs. But Susman's agency in January and February will waive co-pays for generic antibiotics used to treat ailments like sinus infections, to encourage doctors to use lower-cost generic drugs over higher-priced brand-name drugs.
"Doctors look like heroes for giving out samples. We've done the next best thing by waiving co-pays," he says.
West Virginia officials are targeting the specific class of drugs this winter because of use of the medications during the cold and flu season. An average brand-name drug to treat sinus infections costs $64 per month while the average generic costs around $15 per month, Susman says. The state will expand this program in other drug classes later next year.
Susman and colleagues continue to work on the formation of a six-state prescription drug purchasing pool for Medicaid enrollees and state employees and are laying the groundwork for a program known as counter-detailing, which uses pharmacists to encourage doctors to use lower-cost generic drugs when appropriate.
Susman, who has been on the job just shy of one year, remains optimistic that the state's cost-cutting efforts will pay off. "Our governor is very entrepreneurial and if we get an idea, he lets us run with it. I'm extremely happy with the progress we've had," Susman says.