By Mark Hollis
Tallahassee Bureau
Posted January 26 2005

TALLAHASSEE -- Gov. Jeb Bush has launched a plan to save hundreds of
millions of dollars a year by restricting Medicaid patients' access
to only the least expensive prescription drugs.

Bush ordered his top health officials this month to seek legislative
and federal agency approval for his proposal, which would create a
scaled-down list of drugs that doctors can prescribe to the state's
2.1 million poor and disabled, half of whom are children.

The proposal alarms advocates for the mentally ill, HIV-infected and
the poor, who fear that super-new and often super-expensive drugs
that significantly benefit certain patients may not make it onto the
so-called "formulary" list. Mental health advocates say these
patients often rely on a complex array of drugs that could suddenly
be unavailable to them under Bush's plan.

"We will oppose restrictions of that type with regard to psychotropic
medications," said Bob Sharpe, president of the Florida Council for
Community Mental Health, and the state's former Medicaid director.

"It is not cost-effective because the people with mental illnesses
will end up not able to access the right medications at the right
times and it will end up increasing state expenses."

The drug list plan, mentioned only briefly by Bush last week when he
unveiled state spending recommendations for the coming year, would
end the state's 4-year-old effort at controlling drug costs with
a "preferred drug list" that now allows doctors some choice in which
medicines they prescribe. With a "preferred drug list," the state
negotiates with dozens of drug manufacturers to achieve rebates in
exchange for guarantees of putting medicines on the list.

Under the new proposal, the preferred list would be replaced by a
formulary that allows only the least expensive, but still proven
effective, medicines for those on Medicaid.

State health officials who have helped devise the plan say, in most
cases, only one or two drugs -- regardless of whether they are a name
brand or generic -- will be on the formulary for any given class of
medications.

Officials in the state's Agency for Health Care Administration say
there are about 60 classes of drugs under their structure. They
insist, though, that in some circumstances, a greater variety of
drugs could be available -- but only if a state panel of pharmacists
determines that the cheapest drugs aren't the most effective.

"Gov. Bush and Lt. Gov. [Toni]Jennings are committed to protecting
Florida's vulnerable citizens while meeting the challenge of
persistent increases in the cost of the Medicaid program," said
spokesman Jacob DiPietre

Bush's move is estimated to achieve $292 million in savings in the
2005-06 budget year alone and likely greater sums in future years.

Mental health advocates are especially alarmed because it would alter
the current system in which doctors are allowed to prescribe any so-
called psychotropic drug -- or combination of such drugs -- to
patients with mental illnesses.

Those often very expensive medicines include pills such as Zyprexa
and Seroquel, both used for bipolar disorder and schizophrenia. They
also include Zoloft, Paxil and Serzone, often prescribed to people
fighting depression.

Currently, such mental health drugs, along with many medicines for
those with HIV/AIDS, are exempted from the preferred drug list and
the state's policy of limiting Medicaid patients to no more than four
name-brand drugs per month.

For the first time, the new plan, Bush advisers say, would put sharp
restrictions on the availability of all medicines -- including drugs
for the mentally ill and those with AIDS.

State officials, including Agency for Health Care Administration
Secretary Alan Levine, say they have little choice but to pare back
on Medicaid drug spending, one of the fastest-rising parts of the
state budget.

State spending on drugs for Medicaid patients has risen by an average
of 31 percent for the past four years, reaching $2.4 billion by the
end of the current fiscal year, according to state work papers.

The cost-cutting move comes in advance of a major overhaul of the
state's Medicaid program the governor announced on Jan. 11 and is
hoping to win approval for during his final two years in office.

Michael Mathes of Orlando, the immediate past president of the
National Alliance for the Mentally Ill of Florida and the parent of a
child with bipolar disorder, called Bush's new strategy "a very scary
thing" for people who have a brain disorder or mental illness.

"Everybody's brain chemistry is different. ... Our electrical
connections are different," he said. "The different illnesses or
variations of them affect different parts of the brain. The chemicals
and the medications do different things for different people. What
may work for my daughter who has bipolar disorder, the chances are
less than 50-50 will work for somebody else."

Mark Hollis can be reached at mhollis@s... or 850-224-
6214.

HIV doesn't discriminate betwween Democrats or Republicans . . .