Family physicians' knowledge of prescription assistance programs will become invaluable to their Medicaid-eligible patients if a recommendation by the Medicaid Advisory Commission takes effect.
The recommendation -- that Medicaid establish a tiered payment system that would charge more for brand-name and less for generic prescription drugs -- came as part of the commission's Aug. 18 report to the HHS secretary. The report contained six recommendations that, taken together, would eliminate $11 billion in Medicaid spending over a five-year period.
Proposed to the commission by the National Governors Association, a tiered copayment for prescriptions would save $2 billion over five years, the commission report said. Patients would be encouraged to use "preferred" or generic drugs instead of higher-priced brand-name drugs.
The recommendations raised concern among three commissioners, according to Kevin Burke, AAFP director of government relations. They noted that people with severe disabilities or multiple chronic conditions may require a specific mix of medications and often cannot use generic drugs.
The recommendation is of interest to family physicians "because that means the poor who use Medicaid will be subjected to greater cost pressure and would be less likely to use prescription drugs," said Burke. "The physicians who treat them may be in the position of recommending treatment the patients can't afford."
Commission Proposal Could Hike Need for Prescription Assistance
By Leslie Champlin
8/26/2005
A partial solution in such a scenario is to help patients get assistance by steering them to prescription assistance programs, said Burke. Among program options is Partnership for Prescription Assistance, a program that offers help with about 2,500 pharmaceuticals to patients with lower incomes.
Whether the recommendation becomes a part of Medicaid depends on whether HHS Secretary Michael Leavitt endorses it and sends it to Congress and whether Congress incorporates it into legislation.
Other Medicaid Advisory Commission recommendations:
- change Medicaid reimbursement to pharmacies from the average wholesale price to the average manufacturer's price for an expected $4.3 billion savings;
- extend the Medicaid drug rebate program to Medicaid managed care for a $2 billion savings;
- increase the "look-back" period -- the amount of time the government reviews to determine if people have transferred assets for less than market value to qualify for Medicaid -- from three years to five years for a $100 million savings;
- for those who do transfer assets, change the start date of the penalty period from the day they transferred assets to the day they apply for Medicaid for a $1.4 billion savings; and
- reform the tax requirement that applies to Medicaid managed care organizations for a $1.2 billion savings.
