Preferred drug list causes problems, yields little cost saving

June 17, 2009 

Your June 10 article "Clout keeps generics out" overlooked a crucial point: Use of a preferred drug list (PDL) does not work.

Under a PDL mandate, patients and their doctors confront access limitations because the drugs often are selected based on cost and not because they are the right medicines for patients. The state also can lose because when the most appropriate treatments are not available, healthcare costs can rise sharply when patients end up in expensive hospital emergency rooms or on surgery tables.

For example, a 2005 report by the MaineCare Advisory Committee found increased emergency room visits and hospital stays caused by PDL-directed medication changes. In Michigan, the state's PDL limited access to treatments for mental illnesses, heart disease and diabetes diseases common to Medicaid patients.

A 2005 study published in the American Journal of Managed Care suggests there is reason to question whether use of PDL systems in Medicaid generate savings at all. And a new study published in May by the American Psychiatric Association found that Medicaid psychiatric patients subjected to PDLs were 9.7 times more likely to have medication access problems.

Your article says a PDL would push physicians to prescribe generic drugs or less expensive brand-name drugs. That should never happen. Individual patients with the same disease may respond differently to a particular medicine and it is important to have a range of treatment options.

Ultimately, final treatment decisions should be made by the physician and patient. What's more, generic drugs already account for 72 percent of medicines prescribed in the U.S.

There are better ways to provide care while containing costs. Community Care of North Carolina (CCNC) is a good example. By developing regional networks, CCNC, which serves about 725,000 Medicaid patients, is meeting quality, cost and access goals while effectively managing Medicaid patient care. In fact, it saved taxpayers more than $231 million in fiscal years 2005 and 2006.

Clearly, preferred drug lists do not work for Medicaid patients who depend on the state for quality care. It is crucial that these patients have access to an array of treatments, including medicines, so they can get the care that best meets their individual needs.

Ken Johnson

Senior Vice President

Pharmaceutical Research & Manufacturers of America

Washington

The length limit was waived to permit a fuller response to the article.

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