Medicaid Prescription Drugs
Medicaid is the fastest growing part of Utah's budget. A few facts: Medicaid is state health care for the poorest segment of our population; Medicaid involves significant federal matching funds (about $3 from the feds for every $1 Utah spends) -- though these matches likely will shrink, if the feds get serious about balancing the federal budget (as they should); and the system needs reform. On this last point, former Gov. Leavitt (current federal Health and Human Services Director, of course) and legislators like Rep. Becky Lockhart get high marks for putting a good system in place for Utah: better than most, but still in need of reform.
While health care costs in general are skyrocketing, the greatest increase is for prescription drugs. State Health Director Dr. David Sundwall proposes to reduce Medicaid prescription costs in Utah by using a Preferred Drug List ("PDL"). On a trial basis, the Health Department ("Health") would determine which drugs perform the same function for a few specified medical conditions (e.g., drugs X, Y, and Z that all treat acid-reflux). Then, the State would negotiate the price for drugs in that class (including joining with other states to drive the price down further). The lowest-priced member of the class would be the State's preferred drug for that condition.
To give doctors the flexibility they would need, the program also would allow doctors to quickly get authorization for a drug other than the one on the PDL, if, for example, a different drug interacts better with other medication the patient is taking.
Opponents of the PDL argue that it limits patients' choice. They argue that other medical costs, such as doctor visits and hospitalizations, could actually increase as patients switch from one drug to another. And, they argue that the PDL simply will not save enough money to merit the experiment.
Next Tuesday, I will be voting on whether Utah should utilize the PDL. I'm leaning toward allowing it. Thoughts?
While health care costs in general are skyrocketing, the greatest increase is for prescription drugs. State Health Director Dr. David Sundwall proposes to reduce Medicaid prescription costs in Utah by using a Preferred Drug List ("PDL"). On a trial basis, the Health Department ("Health") would determine which drugs perform the same function for a few specified medical conditions (e.g., drugs X, Y, and Z that all treat acid-reflux). Then, the State would negotiate the price for drugs in that class (including joining with other states to drive the price down further). The lowest-priced member of the class would be the State's preferred drug for that condition.
To give doctors the flexibility they would need, the program also would allow doctors to quickly get authorization for a drug other than the one on the PDL, if, for example, a different drug interacts better with other medication the patient is taking.
Opponents of the PDL argue that it limits patients' choice. They argue that other medical costs, such as doctor visits and hospitalizations, could actually increase as patients switch from one drug to another. And, they argue that the PDL simply will not save enough money to merit the experiment.
Next Tuesday, I will be voting on whether Utah should utilize the PDL. I'm leaning toward allowing it. Thoughts?
posted by steve u. at 7/14/2005
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11 Comments:
I dislike the fact that government is in this business at all. However, since my first choice isn't available, I say you should go ahead and vote for it.
My private insurance plan has been doing this for some time and it seems to work quite well, although, there are a few people for whom it causes difficulties. With a program that covers so many people, you have to choose what is best for the bulk. The plan might need to be tweaked to provide some mitigation for extreme cases.
From my perspective and experiences, the present healthcare system in this country is broken. It's the story of the three pigs, the lawyer pigs, the drug company pigs, and the healthcare provider pigs. The problem is undermining the whole economic process in this country. I believe that government must get involved in a controlled and prudent manner to completely overhall the healthcare system. This country wastes so much money on issues that don't provide adequate support for our people. None of these pigs work together and want the whole pie for themselves and are unwilling to analyze, review and rethink this broken system. Healthcare will be only for the richest people if the present system continues without adjustment. Why shouldn't the government be actively involved in the healthcare services of this country, much like education? It is way to complex and powerful and big and too self-serving. Afordable healthcare should be available to everyone in America in my humble opinion.
I recommend you vote for it.
It will limit choices, but that should be a fact of life when the taxpayer is footing the bill. There should be exceptions for medical necessity.
Just a thought:
In 1980, when Reagan took over the presidency, the health insurance companies lobbied for reducing 'their' payout to MD's who were, at the time, making out like bandits. The introduction of the HMO was supposed to be the "save-all" for everyone as it was supposed to drive down health care costs. Health Management Organizations, in reality, didn't save anyone money except the insurance companies. Rather than managing health care, they managed cost (their own cost). People had to get referrals for every visit. MDs had to triple and quadruple the number of patients they were seeing in order to get anywhere near the amount of earnings they were making previously. (Do you recognize the long lines in MD offices...the quick visit...appointments every 5 minutes instead of 15?). At the same time, the cost of malpractice insurance soared up every year.
MDs don't make the same money now; Patients pay through the nose, prescriptions costs continue to soar despite Mr. Bush's assurances. Pharmacies and Insurance companies are making money hand over fist. The quality of health care has gone down (unless you are lucky and have a Doctor who still hold ethics over the almighty dollar.
Yes, Medicaid needs to be addressed, and a solution must be available that works for everyone.
My daughter and her family have no income because she chooses to be a stay at home mom, while she has two Associate degrees and a B.A. in public relations and is doing a wonderful job at it. However, since her husband works at temporary jobs and goes to school, there is essentially no income so Medicaid is what they must rely upon.
Since my health insurance has limited me for some time to certain drugs due to costs (and they don't work as well for me as others I used prior to their limitations) I can keep my heart conditions and acid reflux controlled within reason to keep the costs down.
This should also work well with a PDL in Medicaid since something definitely needs to be done to control medical costs. Please vote for a PDL so that the patient has some chance of keeping outrageous medical costs contained.
This seems like an acceptable compromise given that there is some flexibility for the MD in special cases. Most private insurers are going to similar restrictions, only they allow the insured to get the non-formulary or non-generic drug by paying a larger co-pay or by paying the difference in cost. This is just a short-term fix. Has anyone noticed that the only benefit of Hillary's health care fiasco is that inflation in the health care industry slowed while Clinton was in office? Once Bush and the Reps got in, inflation escalated because the fear of government regulation was gone. I DO NOT favor government control, but if Congress threatened intervention again, health care inlfation would slow down.
Every healthcare plan I've had for the last ten years has included a PDL. I'm currently a State employee, and we have an excellent health plan that includes a PDL. It doesn't bother me at all.
Why shouldn't medicaid have a PDL when most other health plans do? If it cuts costs and provides reasonable care, I say vote for it. After all, medicaid is essentially a welfare program, and, as my mom used to say when I didn't like what she fixed for dinner: Beggars can't be choosers.
Most American don't know this but in 1996-1997 a
bill was passed that made ALIENS eligible for Medicaid. If these Aliens were
refused Medicaid then we wouldn't have the shortage of monies in Medicaid.
Do you realize how many Non-Citizens are on Medicaid. This is where the problem
is with Medicaid.
Any foreigner can come to the US and stay long past the time their work permit
and Medicaid feels sorry for them and enrolls them, even at the cost of
CITIZENS being denied benefits. I had thought that Medicaid was set up for the Citizens of our great country.
No wonder it is broke. Get the illegals off Medicaid and the citizens that need it put back on it.
PDL's might be suitable as a temporary fix, but I don't think it will be anything more than a surface band aid when the real problem is much more systemic.
I believe that we need to return to more of a free-market approach to health care. We could do this if we as a country were willing to address two important issues:
1) The shortage of professionals in the medical field and,
2) The distancing of price for medical service/treatment from the consumer
The American Medical Association (AMA) does a good job of controlling the number of accredited medical schools that will certify doctors to practice. This might be a good thing since it keeps the quality of doctors and their salaries high ($$$). It also has the effect of turning out a fixed number of doctors every year. This is not a free-market approach to health care because it limits the supply of medical care professionals.
Also, Bush administration has repeatedly threatened veto on legislation that would allow re-importation of drugs from Canada. Pharmaceutical lobbies are of course behind such legislation as they have much to benefit by keeping the status quo right where it is ($$$).
To the Bush administration's credit, they have made strides in promoting Health Savings Accounts. Theoretically, this is a good move because it should put the consumer back in charge of how much she pays for health care goods and services. Ultimately this should introduce and element of competition as consumers "shop" their doctors rather than just going to the ones allowed by their insurance provider or their HMO. This is exactly what has happened with corrective vision surgery - the prices for these types of procedures have been forced down because insurance has not covered them and consumers have judiciously shopped around for the best deals.
Another move that the U.S. might try is to make it easier for foreign, qualified medical professionals to enter the U.S. While not a popular move amongst in the medical circle, this could ease the burden on American citizens whose income is not keeping up with the increase in medical costs.
In essence, I agree with jer who states that health should not be "only for the riches people". I also agree with doc in that government regulation in health care does not always produce its intended effect.
PDL's might be suitable as a temporary fix, but I don't think it will be anything more than a surface band aid when the real problem is much more systemic.
I believe that we need to return to more of a free-market approach to health care. We could do this if we as a country were willing to address two important issues:
1) The shortage of professionals in the medical field and,
2) The distancing of price for medical service/treatment from the consumer
The American Medical Association (AMA) does a good job of controlling the number of accredited medical schools that will certify doctors to practice. This might be a good thing since it keeps the quality of doctors and their salaries high ($$$). It also has the effect of turning out a fixed number of doctors every year. This is not a free-market approach to health care because it limits the supply of medical care professionals.
Also, Bush administration has repeatedly threatened veto on legislation that would allow re-importation of drugs from Canada. Pharmaceutical lobbies are of course behind such legislation as they have much to benefit by keeping the status quo right where it is ($$$).
To the Bush administration's credit, they have made strides in promoting Health Savings Accounts. Theoretically, this is a good move because it should put the consumer back in charge of how much she pays for health care goods and services. Ultimately this should introduce and element of competition as consumers "shop" their doctors rather than just going to the ones allowed by their insurance provider or their HMO. This is exactly what has happened with corrective vision surgery - the prices for these types of procedures have been forced down because insurance has not covered them and consumers have judiciously shopped around for the best deals.
Another move that the U.S. might try is to make it easier for foreign, qualified medical professionals to enter the U.S. While not a popular move amongst in the medical circle, this could ease the burden on American citizens whose income is not keeping up with the increase in medical costs.
In essence, I agree with jer who states that health should not be "only for the riches people". I also agree with doc in that government regulation in health care does not always produce its intended effect.
Grace Ann,
I think you are 100% correct. I also think that BUSH needs to spend time on problems of legitimate urgency and not ones that "urgently" benefit big business (Medicare and private accounts)!
Alan (Doc)
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