Drug bills drain large chunk of Medicaid

Drug bills drain large chunk of Medicaid

Medicine costs rise

ELIZABETH COOPER Utica Observer-Dispatch Jan 9, 2005

Of Oneida County's skyrocketing Medicaid costs, prescription drugs make up a hefty portion.

From lifesaving drugs to allergy medications, birth control and even Viagra, the county shelled out about $11.5 million for prescription medications in 2004 alone. That's up 87 percent from 2000.

"It's absolutely out of control," county Social Services Commissioner Theodore Mohr said. "I'm not opposed to the service; I'm opposed to the incredible cost being charged to us."

The state determines which drugs are available to Medicaid recipients, and the county is required to pay 25 percent of the costs racked up within its borders. New York is one of the few states that makes its counties pay a share of its overall Medicaid bill.

Though drug costs make up a big part of the total Medicaid bill, other charges run the gamut, as well. Health maintenance organization plans, the Family Health Plus program, long-term care bills, programs for the developmentally disabled and substance abuser, as well as general medical and surgical expenses, all cost money.

Still, rising prescription drug costs account for $5 million of the county's $21 million Medicaid increase from 2000 to 2004.

State Health Department spokeswoman Kim Volean said the state is carefully monitoring what drugs it allows Medicaid to pay for.

"The state reimburses Medicaid claims for prescriptions based on medical necessity," she said.

Still, Mohr believes the costs need to be reined in, or else the state must take on more of a share.

In 2003, the most recent year available, the total cost was about $40 million -- of which the county paid about $10 million -- for 646,740 claims covering more than 1,000 different medications.

Most of the drugs are very important, if not vital to the lives of those who use them.

Of medicines purchased in 2003, the county paid the most for three antipsychotic drugs. It cost the county a total of $1.2 million to supply 3,257 people with the medications Risperdal for acute bipolar disorder and Zyprexa and Seroquel to control schizophrenia and bipolar disorder.

Both Mohr and advocates for the poor are quick to point out those drugs have tremendous value to the community as a whole, giving people with mental illnesses a chance to live normal lives.

"People taking those drugs have severe mental illnesses and would have to be institutionalized," said Connie Angelini, a benefits counselor at the Resource Center for Independent Living. "The drugs have really enabled them to go to work and have productive lives."

She said if those people were not taking the drugs, they might become homeless or even commit suicide.

Another important, but very expensive drug is Recombinate. A year's supply of the medication for just three people cost the county more than $115,000 in 2003. The total cost to Medicaid was about $461,000.

National Hemophilia Foundation spokesman Glenn Mones said the cost of Recombinate is in line with other drugs of its kind, and it is only prescribed in severe cases.

There are many other drugs prescribed. For example, the county shelled out more than $229,000 for the acid reflux drug Prevacid in 2003. Two other heartburn drugs, Protonix and Nexium, brought the county's acid reflux bill to at least $548,900, prompting County Executive Joseph Griffo to quip in his State of the County Address Tuesday that the price tag gave the county "a bad case of upset wallets."

Mohr said he believes some of the new acid reflux drugs are overprescribed, and patients could benefit from trying changes to their diet or over-the-counter remedies first. He also said the barrage of advertisements for those and other new and expensive name-brand drugs has led to their being overprescribed.

State Health Department spokeswoman Volean said the state encourages the prescription of generics as much as possible.

"We also require that pharmacies fill prescriptions with the equivalent generic drug unless the physician has indicated that the brand-name drug is medically necessary," she said.

Mohr said he believes the state's system is too lax and too often allows Medicaid recipients to get name-brand drugs when they don't need them.

As for the $15,000 Oneida County paid for Viagra in 2003, Mohr doesn't like it a bit, though Arthur Levin of the Center for Medical Consumers said there is a case to be made in favor of providing it to Medicaid recipients.

"It depends what the case is," Levin said. "If a young man has erectile dysfunction because of diabetes, an argument can be made."

A 1999 law passed by the federal government requires Medicaid to pay for all drugs approved by the Food and Drug Administration, Volean said.

"Prescriptions for Viagra must be determined medically necessary by a physician," she said.

The state has implemented strict controls about appropriate medical requirements, and people may receive no more than 6 pills in a 30-day period, she said.

Source: Utica Observer-Dispatch

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