Minnesota's Hard Medicaid Cuts

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Even by the standards of hardball lobbying, it's a startling claim: suicides will surge if a bill to restrain Medicaid spending on prescription drugs is passed. But that's what one lobbyist for Eli Lilly said to Minnesota state Rep. Fran Bradley's face recently. "My phone has rung off the hook with people telling me I'm going to cause a severalfold increase in suicides," said Bradley, a Republican who previously won awards from state mental-health advocates for his progressive legislation.

        Bradley's sin: He is trying to strike an exemption for mental health drugs from the state's "preferred drug list". The exemption was won last year by the pharmaceutical industry, and by mental health advocacy groups which receive funds from the industry. Preferred drug lists, created recently in about half the states in the face of opposition from the drug industry, steer patients toward less costly generics and older versions of pricey new drugs, but allow doctors to prescribe any medication if they call for authorization.

        Now Bradley wants to replace the outright exemption with a grandfather clause that would allow any Medicaid patient who's already on a mental health drug to continue getting it whether it's included on the list or not. Other provisions would ensure access to psychotropic drugs in emergencies while authorization was sought. Committee and floor votes are scheduled this week. Projected savings from the preferred drug list are $20 million per year, with about $5 million of that coming from mental health drugs if the exemption is removed.

        The drug industry argues that Medicaid patients are being treated unfairly. "It really is inappropriate to balance your budget on the backs of poor and disabled Medicaid patients with restricted drug lists," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers Association. And a new Kaiser Family Foundation study finds that not all state preferred drug lists are created equal: Beneficiaries are most satisfied in states that have streamlined prior authorization processes, so they can get their medications quickly, and drug lists that are drawn up in consultation with pharmacists and physicians.

        But many private insurance companies are using similar strategies to hold down costs. And state officials argue that a lot worse is coming if they don't get spending under control. So far, though, that hasn't kept the drug companies from battling to preserve their status as the nation's most profitable industry. One tactic: funding phony grassroots groups. One or more industry-funded groups that go by the names Consumer Alliance, 60-Plus and Medicines Work have fought against lists in Michigan, Maryland, Minnesota, West Virginia, Alabama, Arkansas, Georgia, the Carolinas and other states. A common way they shape opinion is through telemarketing initiatives that give recipients selected facts and then offer to patch them through to the governor or legislature to register their disapproval. In some states, like West Virginia, drugmakers have filed lawsuits to challenge the lists.

        Bradley said that in Minnesota, he's been told by lobbyists that one drug company may pull out of doing business with the state. "They've been using the scariest of scary tactics," he said, "and they have the most well-paid, largest army of lobbyists you could find anywhere. But we ought not to be paying twice or ten times as much money when there's a generic or an identical drug on the market."