Maine’s Medicaid Program to Expand Prescription Pre-authorization Formulary
Maine's Medicaid program is changing its policies to direct doctors toward substitutes for more expensive drugs, when available, the Bangor Daily News reports. Beginning Jan. 1, a greater number of individual prescriptions will require prior authorization from the state before being filled. Also under the new regulations, name-brand drugs can only be prescribed in 34-day supplies, while generics can be prescribed for 90 days, and some medications known to become ineffective after long term use will have "supply limitations." The state, which currently spends close to $200 million annually on prescriptions, hopes the regulations will result in $6.7 million savings over the first two years of the policy. In letters sent to patients and providers, Maine Bureau of Medical Services Pharmacy Program Director Christine Gee wrote that because of the high cost of drugs, the state must "promote clinically appropriate drug utilization practices." Noting that prescribing generic drugs "can net 50% in savings," James Raczek, vice president of the medical staff at Eastern Maine Medical Center, said the changes were "reasonable," but predicted some doctors might complain because the rules "increas[e] administrative burdens." Calling the rule "the biggest piece of garbage that's ever come out of the Department of Human Services," Donald DeGolyer, owner of Lubec Apothecary contends that prior authorization will backlog prescription requests. He noted that state approval for the few drugs already requiring pre-authorization can take as long as three weeks, delaying patient access to necessary medication. DHS spokesperson David Winslow countered that current approvals "take far less time" than three weeks, and that under the new rule, all prescription requests will be addressed in 72 hours or less (Moore, Bangor Daily News, 12/5).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.