By Christopher J. Gearon
April 2002

	AARP.org Links: Prescription Drug Coverage

The country's first state coalition, the Tri-State Prescription Drug Purchasing Pool, formed by Maine, New Hampshire and Vermont, began operating last fall. The three states, by saving an estimated 10 to 15 percent on the combined $387 million they've been paying annually for Medicaid drugs, aim to at least maintain drug coverage for low-income residents.

The Tri-State partners are also part of the Northeast Legislative Association on Prescription Drug Prices, a larger coalition encompassing Connecticut, Massachusetts, New York, Pennsylvania and Rhode Island. The group wants to negotiate directly with drug firms for deep discounts instead of using high-volume purchase orders for savings.

Arkansas, Idaho and Texas are among other states exploring drug-purchasing alliances.

PRESCRIBING CHEAPER DRUGS
Some states are trying to trim costs by limiting the number of drugs available on Medicaid medication lists and by putting the brakes on doctors who unnecessarily prescribe expensive brand-name drugs instead of generics.

	How to Get Low-Priced Drugs • The National Conference of State Legislatures' website offers information on state drug assistance programs for older people. • NeedyMeds.com gives tips on how to get free or discounted medications directly from drug companies. • The Pharmaceutical Research and Manufacturers of America has information on drug assistance programs. Call (800) 762-4636.

Since February, Michigan doctors who treat the state's 1.6 million Medicaid and other low-income residents have been required to get state approval to prescribe the antihistamine Claritin, cholesterol-lowering Lipitor and 335 other costly drugs.

This doesn't mean people can't get the medicines they need. Doctors can prescribe 2,200 other drugs on the state's preferred drug list without approval. They are rarely challenged by the state if they wish to prescribe a more expensive medication.

Without a drug list, the state would have to cut $42 million from health care services, says Michigan Department of Community Health's Geralyn Lasher.

Using a preferred drug list can also help change doctors' prescribing habits, says Cheryl Rivers, executive director of the Northeast Legislative Association on Prescription Drug Prices. The hope is, she says, that doctors will eventually refrain from prescribing costly drugs that require approval when cheaper and equally effective alternatives are available. California, Florida and Maine also maintain preferred drug lists for their Medicaid programs, and other states—among them Arkansas, Idaho, Oregon, Texas and Washington—are considering similar measures.

GOING TO COURT
While more states are experimenting with coalitions and preferred drug lists, they face formidable challenges from drugmakers.

The Pharmaceutical Research and Manufacturers of America has gone to court to stop preferred drug lists for Medicaid recipients in Florida, Michigan and Maine. So far, PhRMA has not won a decision.

PhRMA argues that drug lists are unfair to Medicaid beneficiaries because they limit consumer choice and may adversely affect patients who need special medicines not on the lists.

But AARP plans to file a brief in Michigan's Court of Appeals supporting the state's drug policy, primarily because it does safeguard consumers and ensures that they get medically necessary drugs, according to Sarah Lock, an AARP attorney.

While states are still in the early stages of their attempts to get lower drug prices, Maine has already defeated one court challenge. In late February a federal judge ruled that the state could continue its Healthy Maine drug program.

The drug industry had sued the federal government to stop the Maine program, which gets discounts up to 25 percent from drugmakers for individuals earning up to $25,776 and couples earning up to $34,836 a year.

How states will fare in preserving health benefits for vulnerable citizens is unclear. "At the least," says AARP's Rother, "the states' efforts are putting drug companies on notice that, without a Medicare drug benefit, pressure will intensify for them to lower prices."

Christopher J. Gearon is a Washington-based freelance writer.