Maine Medicaid saved millions Program requires use of generic drugs

Maine’s Medicaid program saved nearly $2.5 million in just three months by steering doctors away from expensive drugs when cheaper substitutes existed.

The program requires doctors to try generics or the least expensive brand-name drugs for their Medicaid patients. If those fail, doctors may prescribe the more expensive brands after getting clearance from the Department of Human Services. Of 1,987 drugs prescribed to Medicaid patients, just 53 are subject to state approval.

The state achieved savings even though the number of Medicaid recipients grew by 6,351, or 21 percent, in the first quarter of 2001. An increased volume of prescriptions was more than offset, because the average price fell from $55.89 in December to $48.97 by the end of March.

In December, DHS officials said they hoped to shave about $3.1 million from the $200 million Medicaid will spend on prescription drugs in Maine this year. But based on the first-quarter results, it looks as though the savings will be much greater, according to David Winslow, a DHS spokesman.

The Maine Medical Association, however, believes the savings don’t reflect increased costs for doctors or the cost of treating medical problems caused by changes in medicine. Doctors spend a lot to administer the program, and changing drugs can inflate emergency room bills, said Gordon Smith, executive vice president of the MMA.

“I think it’s even worse than we thought,” said Smith.

Smith said that in one case, a patient had to be admitted to the hospital because of gastrointestinal bleeding after a prescription was changed.

“There will be all kinds of things like that, but [DHS] will never tell us that, of course,” Smith said.

Winslow said there have been few problems although there would inevitably be individual complaints. The program, he said, is running smoothly. Winslow said doctors’ fears have proved unfounded, although it took time for them to understand the program.

In January, for instance, about 40 percent of prescriptions requiring prior authorization were being denied. As doctors made adjustments, the denial rate dropped to 10 percent, Winslow said.

“I’d hope they’d admit the process has been streamlined,” Winslow said. Among the changes, the state now gives greater prescribing freedom to some specialists, Winslow said. Winslow said the largest chunk of current savings, $914,000, came from substituting for expensive medicines such as Prilosec and Prevacid, which counteract some stomach problems.