Missouri lawmakers backing off Medicaid prescription limit

March 21--Missouri legislators are backing away from a plan to limit Medicaid recipients to five prescriptions, but are still looking for other ways to cut drug costs.

The five-prescription limit was taken out of a bill introduced by Sen. David Sater, a Republican from southwest Missouri, after a hearing this month drew opposition from about 20 groups. Opponents included the Missouri State Medical Association, which represents the state's doctors.

The limit is still in two House bills, but Rep. David Wood and Rep. Lynn Morris said they want to match Sater's bill and would be taking it out of theirs as well.

Craig Dietz, the chief medical officer of the KC Care Clinic, said that's the right call.

"That's pretty unsafe," Dietz said. "Some of our Medicaid patients are the most ill, with the most medications, and it's really easy to get more than five prescriptions on board."

In Missouri and other states that did not expand Medicaid under the Affordable Care Act, the public health program mainly covers low-income children, pregnant women, the elderly and people with disabilities.

Other states have set strict limits on Medicaid prescriptions in recent years, as prices for some drugs soared just as the recession sliced into state budgets.

Illinois set a limit of four in 2012 and that same year Alabama briefly limited Medicaid recipients to just one brand-name drug.

A study published last year by researchers from Harvard Medical School, the University of Washington and CVS found that such limits are likely to cause people on Medicaid to skip preventative medications in favor of those that control immediate symptoms like pain.

Missouri's Department of Social Services already has a five-prescription limit in administrative regulations, but Kamile Johnson, the director of pharmacy at the KC Care Clinic, said it's not really enforced.

"That just means you need to call and explain the dose that the patient is on and what they're using it for," Johnson said. "And they don't block it, but they've been monitoring this, I guess I'll say, for some time."

Sater and Morris are both pharmacists. As a diabetic on several medications, Morris said he too had some concerns about making the prescription limit law, but believed it would be OK because their bills included a long list of maintenance drugs that would be exempt.

Still, Morris said he's willing to compromise.

"We want to make sure people get all the prescriptions they need but I don't want to fill prescriptions people don't need," Morris said. "I'm a taxpayer too."

Morris said he still supports other cost-saving measures, like raising co-pays for Medicaid drugs from a maximum of $1 to $4 for preferred drugs and $8 for non-preferred drugs. Wood said he's pushing for a "polypharmacy program" that would allow the state to appoint a pharmaceutical case manager to coordinate medications for high-risk Medicaid recipients on multiple drugs.

Their bills and Sater's would also reverse a 2008 Missouri law that prevents any state regulation of Medicaid mental health drugs. People who are already on anti-psychotic medications would be grandfathered in, but those seeking new prescriptions could be required to get prior authorization from the state.

Kansas made a similar change in 2015. Cindi Keele, the executive director of the National Association for Mental Illness' Missouri branch, said she's begging lawmakers to scrap that proposal too.

"It's just a bad idea to not let people with psychosis get the medications their doctors think are best for them," Keele said.

Andy Marso: 816-234-4055, @andymarso

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