With the coming advent of ObamaCare, states that are bracing for the huge increase in Medicaid recipients are looking for a way to save money and they think they’ve found one; limiting the number of prescription drugs that Medicaid patients can obtain. The cost for Medicaid will skyrocket under Obamacare because of the expanded eligibility requirements.
As a result of the imminent financial crunch, seven states have tightened the limits on prescription drugs in the last two years, joining nine others that also set limits. Illinois only allows four brand-name drugs for Medicaid patients, Mississippi has a limit of two, and Arkansas adults are limited to six. In Alabama, Medicaid patients were only getting one brand-name drug per month, and HIV and psychiatric drugs were excluded, but on Aug. 1 the state will relax the limit to its previous level — four brand-name drugs — after the state saved more money than expected and received money as part of a settlement with a pharmaceutical company.
Phil Galewitz, staff writer for Kaiser Health News, said the move,
“ … only hurts a limited number of patients. Drugs make up a fair amount of costs for Medicaid. A lot of states have said a lot of drugs are available in generics where they cost less, so they see this sort of another move to push patients to take generics instead of brand. It only hurts a limited number of patients … Some of the states are putting the limits on all drugs. It’s another place to cut. It doesn’t hurt everybody, but it could hurt some.”
But Galewitz recognized that there were some problems with the limitations, as diseases such as asthma and diabetes required name-brand drugs:
“Some doctors I talked to would work with patients with asthma and diabetes, and sometimes it’s tricky to get the right drugs and the right dosage to figure out how to control some of this disease, and just when they get it right, now the state is telling them that, ‘Hey, you’re not going to get all this coverage. You may have to switch to a generic or find another way’ … So it seems like Medicaid’s sort of been one big experiment over the last number of years for states to try to control costs, and it’s an ongoing battle, and I think drugs is just now one of the … latest issues.”
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