Clip files / Local news from the states
Clip files / Local news from the states
This column features selected short items about state health care policy.
Appeals court rules that Vermont cannot offer certain deals for prescription drugs
MONTPELIER, VT—An appeals court has barred Vermont from offering reduced drug prices under a state program, saying a federal agency acted improperly when it approved the program.
Under the program, the state offered enrollees discounts of up to 30%, then required pharmaceutical companies to make up the difference. The Vermont plan had been approved by the U.S. Health and Human Services department.
The program, which has been copied by several other states, was challenged in federal court by a trade group representing the pharmaceutical industry.
A three-judge panel of the United States Court of Appeals for the District of Columbia Circuit ruled that Vermont lacked the authority to offer the same prescription rebates and discounts offered under federal Medicaid insurance.
Congress imposed those rebate requirements to reduce the cost of Medicaid, the court said, but because Vermont’s program resulted in no Medicaid savings, the federal health agency acted improperly in approving it, the judges said.
—Associated Press, June 9
In New York, Medicaid expenses keep going up and are capped by regional lawmakers
ALBANY, NY—Capital region lawmakers called for the state to cap the local share of Medicaid expenses, which Albany County officials say have tripled in the past decade.
If Medicaid costs continue to escalate, the county will be forced to raise property taxes, said Albany County Executive Michael Breslin. The county’s Medicaid bill has gone from $34.7 million in 1996 to an estimated $45.2 million this year to provide health care to 28,677 people.
"It’s a wonderful idea to take care of people who otherwise would not be taken care of,’’ Breslin said. "However, the cost of Medicaid and the way it has been forced on localities is not fair.’’
According to the state Association of Counties, New York is one of two states that make county governments pick up a substantial portion of Medicaid costs. The federal government pays for about half of program for the poor and elderly, while state and local governments split the rest.
—Albany Times Union, June 8
South Dakota legislators propose a rule limiting financial assistance for mental health treatment
SIOUX FALLS, SD—A new rule that would deny financial assistance to some people with mental health problems has a children’s advocate worried.
The state of South Dakota has proposed a rule that would limit financial assistance to families making more than $32,656 a year.
But Susan Randall, director of the South Dakota Coalition for Children, said the rule will deny aid to families that don’t have enough money to pay for expensive treatments.
’I just think this action, if approved by the Legislative Rules Review Committee, is shortsighted,’’ she said. ’It’s a question of paying now or paying later. If some of these kids don’t get treatment now and later their behavior becomes more and more difficult, they could end up in trouble with the criminal justice system.’’
—Yankton Press and Dakotan, June 11
Uncertainty about new technology and training causes Rhode Island to reassess guidelines
PROVIDENCE, RI—The state Health Department has turned away three companies that hoped to offer Rhode Islanders a new technology for diagnosing cancer and other illnesses, saying there are too many uncertainties about the best way to provide it. Instead, within the next few months, the department will develop a set of guidelines for the technology, and then ask for applications that meet those guidelines.At issue is positron emission tomography, or PET, a sophisticated imaging tool that reveals the functioning of tissues. PET has been used in research for many years, but it has also been shown to aid diagnoses of cancer, heart disease, and neurological problems. "We need to go through a standard-setting process," said Patricia A. Nolan, MD, director of the state Department of Health. "One of the major questions about new technology is [whether] there’s adequate training and preparation for the people who use it."
In the case of PET, this is especially important because it uses radioactive materials. In addition to safety, the department wants to makes sure that people are trained well enough to accurately read the scans.
—Providence Journal, June 12
Wisconsin Democrats offer a plan on use of money from anti-tobacco funding
MADISON, WI—A $103 million-a-year prescription drug benefit for seniors was included by Senate Democrats in their version of the state budget, but questions remained over how the plan would be funded.
Then Democrats, meeting in caucus, pushed through a plan to set up a $313 million endowment with proceeds from the sale of the tobacco settlement payment to provide long-term funding for anti-tobacco efforts. That would boost anti-tobacco funding from a proposed $10.5 million a year to a maximum of $31 million a year.
Approval of the prescription drug benefit sets the stage for a battle between Democrats who control the Senate and the Assembly’s majority Republicans, who favor a more modest benefit. The Joint Finance Committee approved a budget that included $44 million for a drug plan, but did not specify details of the program.
—Milwaukee Journal Sentinel, June 11
Increase in health care funding saves Medicaid programs in Oklahoma
OKLAHOMA CITY—A 9% budget increase for the Oklahoma Health Care Authority probably will save the Medicaid agency from seeking another Legislative bailout next year, the authority’s board chairman said.
Funding approved recently by the Legislature is enough to allow all Medicaid programs to be fully functional during the 2002 fiscal year, said Ed McFall, chairman of the authority’s board of directors.
"I’ve been on this commission since day one, and this is the first time I’ve been able to make that statement," Mr. McFall said during the board’s monthly meeting. The board approved the agency’s $2.25 billion budget for the fiscal year which began July 1. The agency provides services to more than 400,000 Oklahomans.
Facing a $20 million budget deficit, board members voted earlier this year to cut some Medicaid services. A $19 million supplement from lawmakers saved the programs. Similar situations occurred in 1995, 1996, 1999, and 2000. During negotiations for the agency’s 2002-2003 appropriations, legislators were concerned that the pattern would continue.
—The Oklahoman, June 15
Mandatory advanced approval for expensive prescription drugs is hailed as a cost-saver
OKLAHOMA CITY—Oklahoma’s health care system for the poor and disabled saved $3.3 million by requiring pre-authorization for the use of popular prescription drugs to treat arthritis and ulcers, a recent report indicates.
"We always strive to match the appropriate medications with our recipients in the most cost-efficient manner," said Lynn V. Mitchell, state Medicaid director.
About 100,000 Medicaid recipients in Oklahoma use either anti-inflammatory drugs with brand names that include Celebrex, Relafen, Indocin, Vioxx, Daypro, and Naproxen, or anti-ulcer drugs such as Axid, Pepcid, Prevacid, Prilosec, or Aciphex.
A study last year commissioned by the Oklahoma Health Care Authority outlined the effects of prior authorization — or mandatory advance approval for the use of expensive medications. The study showed sizable across-the-board savings on all classifications of drugs commonly used to address arthritic conditions and gastrointestinal disorders.
—The Oklahoman, June 27
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