A state Senate committee will look for ways to reduce the cost to the MO HealthNet program to provide prescription drugs to low-income and vulnerable Missourians. It will prepare recommendations to be considered by the new General Assembly that will convene in January.
Senate Republicans say the cost of specialty and generic drugs has risen to more than $1.8-billion. The panel will be chaired by Senator David Sater (R-Cassville) who is both a pharmacist and member of the Senate Budget Committee.
He says increasing pharmacy costs present a budget crisis to the MO HealthNet program and other state programs.
“If we don’t get a handle on it we’ll have to take money away from somewhere else, because that’s just the reality of the budget,” said Sater.
Sater suggests looking for potential solutions in the private healthcare industry, and in other states’ programs.
“Things like step therapy, they have a preferred drug list, non-preferred drug list, they have .certain products that they don’t recommend. We may have to explore some options like that,” said Sater. “Some states even have a monthly prescription limit on maintenance drugs and non-maintenance drugs. To me these things are all on the table.”
Sater says though the increasing costs to the state of prescription drugs is unsustainable, ending that aid is not an option.
“We have too many vulnerable persons out there,” said Sater. “If you discontinue the pharmacy program you’re going to have a lot more hospitalizations, a lot more emergency room uses, and that’s going to be a lot more expensive than paying for people’s medications.”
“Foremost in my mind I want to make sure our Medicaid recipients are taken care of and are not getting inferior care, but they are getting inferior care, really, right now,” said Sater.
The Department of Health is also working on ways to cut costs. One program that was described to the budget committee would have a clinical pharmacist review the needs of Medicaid recipients who are on 12 or more medications, long-term, to see if they can be treated with fewer.
The number would be gradually reduced as far as possible for each recipient. The Department told lawmakers it believes that could save the state $8- to $10-million dollars in its first year and $18- to $20-million in its second.
Sater said several of the ideas that have been discussed would require Missouri to secure a waiver from the federal government.
He expects the committee to meet three or four times before January.