state medicaid policies

the following is a letter that i sent to our state's governor, lieutenant governor, utah department of health medicaid office and executive director, my state legislative representatives, as well as all the major tv stations and newspapers in utah. feel free to email your own representatives about this issue.

To Whom It May Concern:

I am a Certified Pharmaceutical Technician and have worked at the same independent pharmacy for over three years now. We see a significant amount of welfare or Medicaid patients whose prescriptions are paid for by the state. Recently, there have been changes in the Medicaid formulary that have concerned me as well as my co-workers. It seems the state is mandating that some medications be name-brand only, even if there is a generic available. Usually this results in tax payer money being spent on a drug that is ten times more expensive than its generic version. As a tax payer and a member of the pharmaceutical community, I am outraged. I demand to know how our state can justify the costs of these medications.

It is my opinion that we shouldn’t even be paying for pain medications or proton pump inhibitors (PPI, used to treat acid reflux). These are not necessary medications. Our state should only pay for birth control, antibiotics, and necessary maintenance medications, such as insulin, blood pressure lowering medications and cholesterol lowering medications. Instead, our state is paying over $5000 per month on a single person’s Oxycontin prescription.

The state did require that physicians file a prior authorization request in order to cover a patient’s Oxycontin. However, the state has approved every single request we have sent them. On the other hand, they reject the prior authorizations for tizanadine which costs around $4.00 for a 30-day supply. How does this make any sense? Especially when I have seen those same Oxycontin patients pay over $1500 in cash for prescriptions when it is too soon for Medicaid to pay for them again. These patients also have new cars, nice clothes and cell phones. Why are we supporting the drug habits of these people?

Our state needs to be saving money right now, not throwing it away. If we would stop paying for Oxycontin and other brand-name only medications, we wouldn’t have to fire teachers and force our children into crowded classrooms. As a tax payer and a voter, I will not support any politician who approves such Medicaid regulations. I demand that this be changed immediately, on behalf of myself and the entire state of Utah. Below I have listed the cost of some of the medications that Medicaid requires be brand-name with their generic alternatives listed below.

Aciphex 20 mg #90: $525.86 or Dexilant 60 mg #30: $106.82

Omeprazole 20 mg #100: $17.25

Oxycontin 80 mg #100: $1062.08

(Generic oxycodone ER currently unavailable)

MS Contin 60 mg #100: $442.89

Morphine Sulfate ER 60 mg #100: $48.48

Duragesic 75 mcg/hr #5: $268.53

Fentanyl 75 mcg/hr #5: $85.50

Imitrex 100 mg #9 = $216.33

Sumatriptan 100 mg #9 = $11.99

Thank you for your time. Feel free to contact me if there are any questions or concerns or answers.