MEDICAID PUTS CURB ON ABOUT 30 DRUGS

Doctors must get approval to prescribe OxyContin and certain other drugs to
N.C. Medicaid patients, in a cost-cutting move that took effect this week.

More than 30 drugs now require prior authorization from a Medicaid
contractor. All are considered too expensive or easily abused, said
officials with the N.C. Department of Health and Human Services, which runs
Medicaid.

Budget-crunched state officials are trying to cut spending on Medicaid, the
federal-state-county health insurance program for poor and disabled people.
N.C. Medicaid enrolls about 1.2 million, including more than 80,000 in
Mecklenburg County.

"This measure puts the brakes on (spending) and makes sure drugs are
prescribed when they are clinically appropriate," said Daphne Lyon, a state
deputy director over Medicaid.

N.C. Medicaid previously required prior approval for a few drugs, including
Viagra.

Now the list has grown more than tenfold. Additions include OxyContin, the
addictive painkiller; Nicotrol, the tobacco deterrent; Vioxx, the heavily
advertised arthritis medication; and several drugs used to treat
hyperactivity and attention-deficit disorder.

The Consumer Alliance, a Michigan-based organization that gets
pharmaceutical industry funding, is opposed.

Doctors already frustrated by low Medicaid reimbursements may stop seeing
patients rather than deal with the additional headache of prior
authorization, warned the group's president, Don Rounds. Medicaid patients
in other states have suffered for hours while awaiting a prescription
approval, he said.

But health-care providers said prior authorizations are routine for doctors
who deal with other insurance programs.

"As long as this is done efficiently and with a quick response, this should
not affect patient care at all," said Alan Taylor, a spokesman for
Carolinas HealthCare System, the Charlotte-based public hospital organization.

The expanded list may discourage use of expensive brand-name drugs when
others would work as well or better, said Adam Searing, project director
with the N.C. Health Access Coalition, a patient advocacy group in Raleigh.

Prescription drugs are the most expensive part of Medicaid, accounting for
$1.1 billion of this year's $6.3 billion budget.

Last year, Medicaid set higher co-payments for brand-name drugs and smaller
dispensing fees for pharmacists. Those measures will save an estimated $6.5
million this fiscal year, but the program must cut an additional $17.5
million, Lyon said.

The state hired ACS Healthcare of Atlanta as the authorization call center.
The company told N.C. officials to expect savings of $8 million to $10
million a year, Lyon said.