Drug plan savings beat projections State program forces use of cheaper prescriptions

AUGUSTA – Savings from a controversial program that forces Medicaid patients to use cheaper prescription drugs are running 50 percent above projections, Maine Human Services Commissioner Kevin Concannon said.

Recent figures show that the “prior authorization” program resulted in savings of $15 million last year, rather than the $10 million that the department had anticipated, according to Concannon.

At the same time, the state bought more prescriptions: 4 million prescriptions at a cost of $210 million in 2001, compared to 2000 when the state bought 3.3 million prescriptions for $185 million.

The additional savings come at a time when the Legislature is poised to grapple with a state budget shortfall estimated at about $250 million.

The program, which has come under criticism from the Maine Medical Association, requires doctors to obtain state approval before prescribing certain expensive drugs that have been placed on a state list. If permission is not granted, doctors must prescribe cheaper medicines, such as generics.

The expensive medications are often those heavily advertised, Concannon said. He said taxpayers who pay for Medicaid patients should pay for lower-priced medicines if they do the job.

When doctors give the state compelling reasons why the expensive medicine is needed, “we’ll approve it,” Concannon said.

“Most doctors say, ‘Let’s not go through the hassle,’ and write a cheaper prescription. In the last year 34,000 prior authorizations were granted, less than one out of every 100 prescriptions. The program is working,” he said

Concannon said he is unaware of problems for patients forced to use less expensive medicine. Opponents of prior authorization, which include doctors and the pharmaceutical industry, “scoured the state looking for a poster child, an example of someone who needed a drug and didn’t get it,” he said.

“Most doctors I talked to are fine with it. They’ll tell you about patients coming in asking for” medicine they’ve seen in advertising. “To the extent that we say, ‘No, it costs three times as much,”‘ that gives credence to doctors trying to discourage patients from asking for what they saw on television, Concannon said.

A spokesman for the Maine Medical Association, which represents doctors, disagreed about the impact on patients.

“It’s all driven by the numbers,” said Gordon Smith, adding that it has nothing to do with quality of care and is only about saving money.

“He doesn’t hear what he doesn’t want to hear,” Smith said of Concannon, citing the case of a woman who was hospitalized in Lewiston after her medicine was changed.

Gov. Angus King said he is pleased at how the program has saved money without compromising patients.

“In the context of solving this budget problem, anything with six or seven digits is significant,” King said.