EDITORIAL: Using a drug formulary is a no-brainer for cash-strapped program [Star-News, Wilmington, N.C.]

Mar. 20--Now, here's an idea so sensible -- and a practice so common among private insurers -- that it's a wonder North Carolina's Medicaid program doesn't use it already: a preferred drug list to discourage doctors from prescribing high-cost medications if a cheaper drug can do the job.

State officials looking to find savings wherever they can say that Medicaid could save $90 million by providing doctors with a list of preferred generic and lower-cost alternatives to more expensive brand-name drugs.

That's a practical solution to help rein in health costs, which are driven in large part by the price of prescription drugs.

According to the Associated Press, Gov. Mike Easley's administration proposed the idea back in 2002. The Honorables didn't go along, pressured by lobbyists for drug companies who feigned concern that poor people might not get the medications they need. Or, more to the point, that such a policy might cut into profits for expensive brand-name drugs.

But now, faced with $250 million more in expenses than available revenue, the state's Medicaid program is looking for cuts anywhere it can get them. Officials are revisiting the preferred-drug idea.

The proposal is similar to formularies already provided to Medicare and many privately insured patients with prescription drug coverage.

The way many of those work, typically, is that the insurer reimburses a higher percentage of the price for drugs on the "preferred" list while charging higher copayments for brand-name drugs when there is an effective, lower-priced alternative available. The idea is to help insurers control costs.

In such cases, the patient has the choice to buy a brand name, if willing to pay the often-substantial difference in price.

Asking consumers and doctors to try lower-price medication that has been proven effective for their condition is not "rationing" of health care. It is good, old-fashioned common sense. Most private-pay patients would want to save money if possible by choosing the generic brand if it works; those whose care is financed by the taxpayers should be encouraged to help hold down costs, too.

As long as there is a mechanism to ensure that patients who really need a specific brand-name drug aren't denied coverage, this seems like a no-brainer.

There may be details to work out, and experts will differ as to which drugs should be on the list. But $90 million is a substantial amount of money, even if it is only a small chunk of the budget hole the Honorables will be looking to close when they meet this year.

This idea has promise; it is worth a try.

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