State Initiatives to Control Medicaid Drug Costs

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     To the Editor: Mello et al. (Feb. 5 issue)1 describe initiatives to control states' expenditures for drugs, including multiple mechanisms for forcing physicians to obtain approval to prescribe drugs. Physicians working to provide appropriate treatment thereby become grubbing middlemen between Medicaid and manufacturers, having to negotiate or plainly beg for coverage. Although the goal of prior-authorization programs is to reduce costs by eliminating inappropriate prescribing, the programs impede both inappropriate and appropriate prescribing. Physicians facing complex medical decisions in the small amount of time between visits must shift their attention to discuss indications for drugs with insurers. These clerical tasks hinder care.

    Physicians should focus on patients and medical decisions. Useful alternatives to authorization are available in decades-old technology. Formularies of manufacturers, payers, and providers could be updated, integrated, and queried with computer networks. Creating this system requires a large and coordinated effort, which would perhaps best be undertaken in the public sector. Standards for electronic records and health care communications will facilitate these developments. Powerful systems will combine clinical and demographic data to help physicians identify documentation and indications for drugs. The decision to pit technology against this problem seems straightforward.

    Michael Weiner, M.D., M.P.H.

    Regenstrief Institute

    Indianapolis, IN 46202-2872

    mw@cogit.net

    References

    Mello MM, Studdert DM, Brennan TA. The pharmaceutical industry versus Medicaid -- limits on state initiatives to control prescription-drug costs. N Engl J Med 2004;350:608-613.

    http://www.100md.com/html/DirDu/2006/11/29/30/56/08.htm