Medicaid short list: Prescribing a hassle factor

States view Medicaid preferred-drug lists as money savers. Many doctors see them only as barriers to care.

By Geri Aston, AMNews staff. May 3, 2004.

A necessary evil. That's how James S. Powers, MD, an internist specializing in geriatrics, describes Tennessee's Medicaid preferred-drug list.

Dr. Powers' vantage point allows him to see the pros and cons of the effort to rein in his state's Medicaid drug spending. He chairs the board that recommends to the state which drugs should be on the list.

As a physician, he recognizes the burden the PDL can put on doctors. Physicians who want to prescribe a drug that's not included must get prior state approval.

"It's cumbersome. The hassle factor turns off physicians," said Dr. Powers, associate professor of medicine and head of senior care services at Vanderbilt University Medical Center in Tennessee.

But as head of the advisory board, he believes that the alternatives would be worse. If the state doesn't control drug costs, Medicaid rolls would have to be cut.

The task, then, was to create the best drug list possible, Dr. Powers said. Tennessee's PDL, launched last fall, isn't 100% perfect, he said. "There are always compromises."

Dr. Powers' experience lays out issues being debated across the country as states have embraced this approach as a way to cut burgeoning Medicaid budgets during a time of fiscal crisis. Florida implemented a PDL first, in July 2001, and was followed quickly by Michigan in early 2002.

After these programs withstood initial legal challenges, other states followed. Now, preferred-drug lists operate in 26 states and are pending in 10 others, according to the National Conference of State Legislatures.