Drug-cost program may change
By Robbie Dingeman
Advertiser Health Writer
Even though the Supreme Court has cleared the way for states to try to force companies to lower prices on prescription drugs for the poor and uninsured, programs designed to do so in Maine and Hawai'i face another hurdle — resistance from the U.S. Department of Health and Human Services.
The agency, which oversees Medicaid programs nationwide, would need to approve any state program because of its potential impact on Medicaid patients. As proposed, programs in Maine and Hawai'i would bar doctors treating Medicaid patients from prescribing products sold by companies that don't take part in the discount program unless they obtain permission from the state to prescribe those specific products.
If that roadblock prevented patients from getting the medicine they needed, it could affect care in a way that could hurt Medicaid recipients, the Bush administration said in a legal brief filed in the U.S. Court of Appeals.
"What it does do is create a hurdle for a Medicaid patient to get a drug manufactured by a manufacturer who isn't participating," said state Department of Human Services Director Lillian Koller.
On Monday, the U.S. Supreme Court ruled 6-3 to let a new approach to reducing the costs of prescription drugs take effect in Maine. Hawai'i advocates say it paves the way for a similar program to move forward in Hawai'i.
Advocates say the requirement that doctors get "prior authorization" when they want to prescribe drugs made by companies not participating in the discount program is already used in various states for Medicaid patients without objection from federal officials.
One of the key backers of the Hawai'i Rx program is state Rep. Roy Takumi, who doesn't believe the additional step for doctors will stall the program locally or in Maine.
Takumi, D-36th (Pearl City, Palisades), said many states use the authorization requirement "to control their spiraling drug costs."
Koller and Takumi said Maine and Hawai'i can modify the proposed design of the program to address these concerns. Hawai'i Rx was approved by the Legislature last year and is modeled after Maine's program. It would create a purchasing pool that would negotiate discounts with drug manufacturers on behalf of those in the pool. Hawai'i Rx members would then be able to buy those drugs at local participating pharmacies at discounted prices.
Supporters, including AARP Hawai'i, say the program would provide relief to about 220,000 Hawai'i residents who do not have prescription-drug coverage. It's unclear whether Gov. Linda Lingle will approve the $200,000 critical to setting up the program after expressing concerns there may be other legal challenges.
Greg Marchildon, state director of AARP Hawai'i, which advocates on behalf of retired people, said the states should proceed with a program that could save millions of dollars for consumers.
Takumi said some doctors and patients may opt for other medication rather than go through the hassle of more paperwork that comes with prior authorization requirements, but he said such programs do reduce costs. Studies show that the money the drug companies lose to discounts are made up in volume because they sell to patients who would have gone without or skipped some doses because of the cost, Takumi said.
Koller thinks a new bipartisan task force will help to find solutions to the skyrocketing cost of prescription drugs, but Marchildon disagrees. "Setting up yet another task force is not going to solve the problem. We've already gotten past that."
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
