States Limiting Drug Prescriptions for Medicaid Patients
Seven of those states, according to Kaiser Health News, have enacted or tightened those limits in just the last two years.
Medicaid is a federal program that is carried out in partnership with state governments. It forms an important element of President Barack Obama’s health-care plan because under the Patient Protection and Affordable Care Act–AKA Obamcare–a larger number of people will be covered by Medicaid, as the income cap is raised for the program.
With both the expanded Medicaid program and the federal subsidy for health-care premiums that will be available to people earning up to 400 percent of the poverty level, a larger percentage of the population will be wholly or partially dependent on the government for their health care under Obamacare than are now.
In Alabama, Medicaid patients are now limited to one brand-name drug, and HIV and psychiatric drugs are excluded.
Illinois has limited Medicaid patients to just four prescription drugs as a cost-cutting move, and patients who need more than four must get permission from the state.
Speaking on C-SPAN’s Washington Journal on Monday, Phil Galewitz, staff writer for Kaiser Health News, said the move “only hurts a limited number of patients.”
“Drugs make up a fair amount of costs for Medicaid. A lot of states have said a lot of drugs are available in generics where they cost less, so they see this sort of another move to push patients to take generics instead of brand,” Galewitz said.
“It only hurts a limited number of patients, ‘cause obviously it hurts patients who are taking multiple brand name drugs in the case of Alabama, Illinois. Some of the states are putting the limits on all drugs. It’s another place to cut. It doesn’t hurt everybody, but it could hurt some,” he added.
Galewitz said the move also puts doctors and patients in a “difficult position.”
“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way,’” he said.
Arkansas, California, Kansas, Kentucky, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia have all placed caps on the number of prescription drugs Medicaid patients can get.
“Some people say it’s a matter of you know states are throwing things up against the wall to see what might work, so states have tried, they’ve also tried formularies where they’ll pick certain brand name drugs over other drugs. So states try a whole lot of different things. They’re trying different ways of paying providers to try to maybe slow the costs down,” Galewitz said.
“So it seems like Medicaid’s sort of been one big experiment over the last number of years for states to try to control costs, and it’s an ongoing battle, and I think drugs is just now one of the … latest issues. And it’s a relatively recent thing, only in the last 10 years have we really seen states put these limits on monthly drugs,” he added.
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