Fight brews over prescription cost

Patient advocates praised the Senate on Wednesday for rejecting two proposals that they said would deny doctors the ability to prescribe the best drugs for patients.

The state Medicaid Redesign Team has recommended prescription management policies that steer doctors and patients toward cheaper drugs deemed equally effective. The redesign team also proposed eliminating the "prescriber prevails" rule, and instead would make the Medicaid director the final authority on doctors' requests to use drugs that are not on the Preferred Drug List.

Rebecca O'Keefe, of Loudonville, said the proposals would hurt her 10-year-old son, Alex, who had a kidney transplant five months ago. Alex takes two brand-name anti-rejection drugs, and she fears he would be forced to take generic versions that have never been tested on children.

"For the state to alter his medication when he is doing so well is appalling," O'Keefe said.

Senate Republicans are leading the effort to reject the proposed changes to the prescription drug program, but the Assembly budget plan includes the measures.

"It's important that we look at the personal side of health care, not just the monetary side," said Sen. Kemp Hannon, chairman of the Senate Health Committee, who spoke at a news conference sponsored by several advocacy groups including the National Kidney Foundation, the National Alliance on Mental Illness and the Lupus Foundation of Mid and Northeastern New York.

The redesign team estimates the two proposals would save the state $139 million annually. In many cases, patients would have to try generic drugs before being allowed to take brand-name drugs.

Diane Mathis, a spokeswoman for the state Department of Health, said the proposals would have no negative impact on Medicaid patients because no drugs are excluded.

"The goal is to give patients access to the most cost-effective drug," Mathis said. "The current mechanism known as 'physician prevails' that allows physicians to override New York's Preferred Drug List is very seldom used. It was utilized by physicians during the past year for only 3,000 out of 50 million Medicaid prescriptions."

Taxpayers are currently paying more for prescription drugs than they should because the physician-prevails rule weakens the state's ability to negotiate with pharmaceutical companies to get the best prices and drug rebates, Mathis said. Still, advocates are lobbying the Assembly and Gov. Andrew Cuomo in hopes of convincing them to reconsider the prescription drug changes.

"Eliminating the existing safeguards will only jeopardize patients' health and deny them necessary medical care," said Kathleen Arntsen, of the Lupus Foundation.

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