As a rural primary care physician with more than 20 years of experience, I will happily jump through administrative hoops for my patients – as long as the hoops make sense and lead to better healthcare.

But, I won’t stand back silently as state officials attempt to place yet another bureaucratic hurdle in the way of my time spent with patients, especially when it is not only senseless, but will actually compromise care. The Department of Human Services’ new plan, instituted Jan. 1, to subject many new medications to “prior authorization” before they will be covered by Medicaid, will hurt Maine’s most vulnerable citizens – the blind, disabled, aged and children – whose health will suffer as a consequence. The Medicaid waiver recently granted to Maine by the federal government means that this prior authorization program may soon be affecting many more patients.

Before the beginning of the year, my patients on Medicaid could receive the prescription medicine I, their physician who knows them and their medical histories best, select as the most effective treatment with the least undesirable side effects. This makes sense for Maine taxpayers because under the federal law, drug makers must sell these drugs at the lowest possible price. Unfortunately, the state’s newest proposal undermines a physician’s decision-making authority by limiting a patient’s access to a whole list of drugs.

Bureaucrats – and not physicians – are making health-care decisions for this vulnerable group of patients. It allows a private vendor to the state Medicaid office – someone who has never even met my patients – to tell me which drugs I can prescribe for them.

It puts limits on dosages that I can prescribe. It is swamping my office with unnecessary paperwork. Physicians’ offices are already overwhelmed with administrative tasks. I’m amazed at DHS Commissioner Kevin Concannon’s continued public comments minimizing the burden of this prior authorization process on physicians and patients. Clearly, he is out of touch with rural primary care medicine.

Not only does Commissioner Concannon minimize the administrative burden of the program, he, though lacking medical training, arrogantly claims that this program actually improves medical care by interrupting poor prescribing practices by physicians. But, he cites only anecdotal evidence of well-publicized problems with Oxycontin and limited other narcotics.

Contrary to the commissioner’s assertions, I have had a number of experiences in my office in which this program has interfered with good patient care. Just the other day, I had a consultant pharmacist instruct me that my elderly schizophrenic patient, who has required repeated electroconvulsive therapy for relapses, could no longer receive 1.5 mgs of Risperdal twice daily, but that 1 mg in the morning and 2 mg at night would be considered appropriate. Not only is this meddling patently absurd, but potentially destabilizing for the patient and time consuming for me and my staff – diverting us from direct patient care.

Prescribing decisions should be made by physicians through direct involvement with the patient and should be based on science and likely outcomes, not solely on cost. Several national studies indicate that prior authorization programs are not cost effective and do not support good patient care.

In a 1989 analysis of a number of Medicaid cost containment studies, Frank A. Sloan, Ph.D., a Vanderbilt University economist, concludes that prior authorization will not inevitably produce savings for the state. Prior authorization may decrease expenditures for prescription drugs, but it also is likely to increase spending on physicians’ services, emergency room visits and hospitalizations. In California’s Medi-Cal prior authorization program, the increase in administrative cost alone was more than it could have saved in reduced drug costs.

In a 1992 analysis of Arkansas’ Medicaid Drug Prior Authorization Program, Robert R. Robinson and Z. Lynn Zeno substantially discredited the state’s savings projections.

The state had projected savings of approximately $600,000 per month. The Robinson/Zeno study concluded that in the best case scenario the state of Arkansas would save $146,000 annually while in the worst case scenario the state would lose $1.1 million annually.

A key component of these findings is that treatment failure and the promotion of alternative, more expensive forms of therapy such as hospital and physician office visits increased costs by $46 million during a five-month period.

It’s not too late to stop this foolishness. Before state legislation complete their approval of the new biennial budget, on behalf of Maine’s physicians and the patients they care for, I urge them to look at the bigger picture.

Prior authorization and other restrictions on access to prescription medicines may cut the immediate drug budget, but they likely will increase health care costs elsewhere. Prior authorization of drugs in the Maine Medicaid program just doesn’t make sense.

David J. Simmons, M.D., is an internist practicing in Calais and is a past president of the Maine Medical Association.