California Medicaid Program Enacts Tighter Controls on Drug Used To Treat AIDS Wasting
In an effort to combat the black market sale of Serostim among bodybuilders and other people, California officials on Thursday announced the enactment of tighter restrictions on the drug Serostim, which is used to treat AIDS wasting and which officials say has cost the state's Medicaid program $175 million in the past four years, the Los Angeles Times reports. Beginning June 1, Medi-Cal will limit initial prescriptions of the drug, which helps to build muscle mass, to four weeks and will require pre-approval before reimbursing new prescriptions for the drug. Currently, Medi-Cal beneficiaries are allowed to receive up to three months worth of the drug with a doctor's prescription and no prior state approval. Similar restrictions are already in place in the state's AIDS Drug Assistance Program, which provides antiretroviral drugs and other treatment to people who do not qualify for Medi-Cal. Officials predict that the new restrictions will save the state $7.5 million a year. Officials previously resisted adopting prior-authorization restrictions because they feared the rules would prevent AIDS patients from accessing the drug, the Times reports. Recent reports of counterfeiting and fraud, including reports of abuses by bodybuilders and others who buy the drug through the black market, and budgetary concerns prompted officials to make the change, Stan Rosenstein, state deputy health director for medical care services, said. Officials estimate that black market sales of the drug have cost the state tens of millions of dollars, according to the Times. One statewide black market ring involved the sale of more than $3.5 million in Serostim, obtained through Medi-Cal and then sold at gyms and spas. Michael Weinstein, president of the AIDS Healthcare Foundation, estimated that the new restrictions will reduce usage of the drug by approximately 80% and will reduce Medi-Cal reimbursement for the drug from $33.2 million last year to between $6 million and $7 million next year. David Pieribone, the associate director for education at AIDS Project Los Angeles urged officials to monitor whether the new restrictions were preventing deserving patients from receiving the drug. "If it's saving money, great. ... But maybe they're saving money at the expense of patient lives or disease progression. That is important too." State officials also said that the same requirements will apply to oxandrolone, an anabolic steroid used to prevent AIDS wasting, amid fears that Serostim users may try to switch to oxandrolone because of the new restrictions. In a separate effort to contain spending, officials announced prior-approval requirements for the new antiretroviral drug Fuzeon, which costs more than $20,000 per patient per year (Reiterman, Los Angeles Times, 4/4).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.