Florida Medicaid Program Adds HIV Drugs to Formulary Despite Objections
Reversing an earlier decision, Florida Medicaid officials announced yesterday that a new Medicaid drug formulary will include some HIV drugs, the Orlando Sentinel reports. Designed to "tri[m]" $214 million annually from the state's Medicaid budget, the formulary is intended to "limit" brand-name medications available to Medicaid beneficiaries. Over the last month, Medicaid officials had been working to reach agreements with drug manufacturers, who must offer the state discounts of at least 25% to have their drugs on the list. Doctors can prescribe drugs not on the formulary but first must obtain state approval on a patient-by-patient basis. The Sentinel reports that "late last week," state Medicaid officials had indicated that HIV drugs would not be included on the formulary. But yesterday, Medicaid Director Bob Sharpe said that the agency decided to list some HIV drugs made by companies offering discounts. Physicians on the Pharmaceuticals and Therapies Committee, which is helping compile the formulary, maintain that the HIV drugs should not be listed on the formulary because doing so might cause confusion about which HIV drugs doctors are permitted to prescribe, since all HIV drugs can be prescribed without prior approval under state law. Sharpe, however, said that the HIV drugs would remain on the formulary because if they were eliminated, the "discounts will go away and Florida will lose millions of dollars." As a compromise, the committee agreed to include instructions on the formulary in "bold lettering" that HIV drugs not on the list can be prescribed without prior state authorization. Juanita Hernandez-Black, president of the Mental Health Association of Central Florida, criticized the compromise, saying that doctors would still "assume" they could only prescribe drugs on the formulary. She said, "We are adding more layers of complexity to a process that is already confusing." The new formulary takes effect July 1 (Groeller, Orlando Sentinel, 6/27).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.