Generics required for new Medicaid prescriptions

YAKIMA, Wash. -- The state is moving ahead with a plan to require the use of generic drugs for some new prescriptions filled for residents on Medicaid.

The move is intended to find savings in the state's annual Medicaid prescription drug bill, which totaled $413 million in 2008. Each 1 percent increase in generic use would save the state $4 million, according to the state Department of Social and Health Services.

The new prescription policy, approved in 2009 legislation, has been controversial among some doctors and mental health professionals, who say generics aren't always equivalent to brand-name drugs.

Dr. Stan Flemming, president of Pacific Northwest University of Health Sciences, said the rules to administer the law boxes physicians into a corner.

"You're forcing the physician to be overridden by someone with no history of that patient," Flemming said in a telephone interview. "They're putting money ahead of patient safety."

Flemming added that a pharm-acy once switched a prescription he wrote for a patient to a generic drug without his knowledge. The patient had an allergy to a chemical agent in the generic and died, he said.

But Dr. Jeffrey Thompson, chief medical officer for the state Medicaid program, said no one currently on a brand-name drug will be forced to switch to a generic. The rule initially will apply only to Medicaid clients who have never taken a brand-name or generic drug -- called new starts.

The first drugs to fall under the generic-first plan are those to treat heartburn, antipsychotic medication for children and drugs for attention deficit disorder in children and adults.

The rule was approved this week by a committee made up of clinicians and mental health professionals, Thompson said, and provides for what he called a safety valve.

"If the prescriber can tell us the rationale for a branded drug, we would pay for it," he said.

Thompson said Washing-ton is behind other states in moving to generics. Currently, about 63 percent of the medicines filled under Medicaid in Washington are generic compared with 80 percent for other states.

Rick Weaver, chief executive of Central Washington Comprehensive Mental Health, said he understands the need to save money. But patients with mental illness who quit taking a certain medication and then become ill need to be back on the right drug immediately, he said.

Weaver said he's concerned the new system won't recognize the drug that worked for the patient and will automatically assign a generic, leaving the patient vulnerable to a medical setback.

Thompson said the state will introduce a generic-first policy early next year for adults on antipsychotic medicine that will include safeguards to prevent the scenario that Weaver is concerned about.

* Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.