An attempt to save money with cheaper prescriptions causes backlog.
By Kathryn Skelton
Staff Writer

Pharmacist John Bartash turned down three customers Thursday morning. He’d filled each prescription one extra time, but couldn’t do that again. The state hadn’t approved their drugs.

It seems a cost-saving change to the MaineCare program has caught some patients off guard.

Last summer, the state drew up and distributed to doctors and pharmacists a list of more than 6,000 prescription drugs, filing them under two headings for MaineCare, or Medicaid. There are those that needed a special doctor’s form – and state approval – to take. And those that didn’t.

Doctors had until fall to either switch patients to a preferred drug or send in a fax to the state making a case to use a non-preferred one.

Only the deadline has passed and not everyone’s done that. There’s a bottleneck of paperwork at some doctor’s offices. Some people are missing pills.

Becky Fontaine has more than 15 charts on her desk, all from patients whose medical history has to be researched before prior-authorization paperwork can be filled out, new medicine gotten.

All those requests came in the last two days.

Fontaine, a registered nurse team leader at the Elsmore Dixfield Center, said people are running into the issue when they go to the pharmacy to get a refill and get denied.

Saying no, and phoning doctor’s offices to start up the paperwork, has been Bartash’s reluctant role. He said he spent 20 minutes on the phone recently, trying to secure a prescription that will ultimately net his pharmacy, the Rumford Drug Store, less than $5 a month.

“That doesn’t pay the bills,” Bartash said.

There is room to make the system more user-friendly, Department of Human Services spokesman Newell Augur said.

The preferred drug list took effect July 1, the result of a Legislative push to save $100 million in MaineCare drug costs over two years, he said. The pharmacy benefit is the biggest cost in the whole program, Augur added.

MaineCare drug costs, before rebates, are projected to be $300 million from mid-2003 to mid-2004. He anticipates the program filling 6.5 million prescriptions in that time, 200,000 of which will require prior approval for both new and current users.

So far, the state has OK’d 80 percent of the non-preferred drug requests, Augur said. “The idea is we can still save money and provide the service.”

DHS contacted providers to try for a smooth transition, he added. Oct. 1 was the last date by which patients had to be switched or approved.

Pharmacists were allowed to fill one additional month after the prescription ran out and give patients a warning, Bartash said.

“That has not proven to be enough time and we’re talking a lot of people,” he said. “It’s proved to be a chaotic situation.”

It didn’t help that the list of preferred and non-preferred drugs is 24 pages long, and not in alphabetical order but category of treatment.

Lou Gagne, a pharmacist at the Medicine Shoppe in Lewiston, said he heard from more frustrated customers in September, when the initial phase of the program went into effect. “It was pretty bad that first week or so,” he said. MaineCare “won’t pay for it until the authorization goes through.”

Augur said the place to air complaints about the preferred drug list process would be at the next meeting of the MaineCare Drug Utilization Review Committee, on Nov. 18 in Augusta.

kskelton@sunjournal.com

Copy the Story Link