By Allen Christensen
Utah State Senator, District 19

I have been the chair of the Health and Human Services Committee for eight years. I understand the necessity for balanced compassion. Currently one third of the State’s budget goes to Social Services. For obvious reasons, over the last few years, every appropriations committee has been told that if we need an increase in our budgets, we need to find the money internally. For most departments, that means cutting the budget in one category and transferring that money to another category. Savings created by the preferred drug list has given the social services budget an additional income source and the ability to cover many of those increased budget demands.

Many medications on a Preferred Drug List are subject to manufacturer rebate arrangements between the insurance provider and the drug manufacturers. In 2007, we passed legislation that created a Preferred Drug List to be used with state Medicaid patients. We anticipated the savings from the creation of this list would be between $6 and $8 million. In 2011, we saved $27 million—nearly four times the original estimates.

Mental health drugs account for one-third of our Medicaid drug expenditures. Yet there is not a Preferred Drug List for psychiatric drugs. If such a list were created, the fiscal analysts estimate a savings of $3 million taxpayer dollars, from manufactures rebates on these drugs. This is not an unusual practice. We are one of only seven states who do not currently employ this method of saving.

Some are worried that because of the complicated nature of diagnosis and stabilization processes that creating a PDL for psychiatric drugs will somehow inhibit the immediacy often required in the treatment process. Let me address this and some of the other “what if” questions that I have received.

First, some definitions:

1- What is a Preferred Drug List?

A Preferred Drug List is a list of drugs that are selected based on results of extensive and recurring medical research that examines effectiveness, safety and cost. Because of the amount of research done, insurance companies use the lists to guide patients to the most effective drug.

2- How are drugs selected for the list?

The drugs are selected by a set of committees. The first looks at drug effectiveness and then a second committee look at costs. Effectiveness issues always trump costs, but the goal is to make costs come into line with effectiveness, not the other way around.

Some Questions:

* What if the drug I need is not on the list?

First, the drugs on the PDL are generally the most commonly prescribed drugs because they work the best. However, if a need arises, the bill explicitly allows the prescribing doctor or assistant, to override the list and prescribe something different.

* What if I have already been stabilized on a drug that is not on the PDL, do I need to switch to a drug that is on the list?

No. If you were stabilized within the previous three months, then you will be granted an override.

* What if it I need to try several different drugs to find the best medication for me?

The PDL compiles the best drugs in each category. It is almost always the best place to start. It can be very expensive to go through a series of drugs to try and determine which will work the best. This is just one more reason why a PDL will be helpful.

* What if I need the expensive injectable version of the drug?

Fine. However, that already requires prior authorization.

* Who is supporting this bill? Why?

The Utah Medical Association and Utah Academy of Family Physicians are two groups that support this bill. They support the bill because using a Preferred Drug List is recognized as an effective way to guide drug selection for patients. Drugs on the list are generally the most commonly prescribed drugs, because they are the drugs that work the best. They also support the bill because both groups recognize that this is a necessary step to procure the funding vitally necessary to help with program overload and patient waiting lists.

* Who is not supporting this bill? Why?

Pharmaceutical manufacturers oppose the bill. Remember there are two different committees that must approve the placement of a drug on the list. This bill will put the drug manufacturers in a position where they might need to rebate more dollars to the state. This will cost them money.

SB85 helps patients, controls costs and saves the state money.