Health care and patient groups backed by the pharmaceutical industry are battling the state of Georgia's health insurance plan over restrictions on a popular acid reflux drug.
The fight over proton pump inhibitors such as the heavily advertised Prilosec presage future battles as the state seeks to rein in its increasing drug costs in the midst of $52 million in budget cuts while providers battle for their patients. The fight in Georgia is being replayed across the country as other states also seek to cut drug costs.
The Georgia Academy of Family Physicians and the Georgia chapter of the National Alliance for the Mentally Ill held a conference call Tuesday to talk about a poll in which most people said state employees and Medicaid patients should have the same health benefits and access to drugs as private-sector employees.
The groups are part of The Medicines Work Coalition, whose members include the Pharmaceutical Research and Manufacturers of America, the trade group for the pharmaceutical industry, often referred to as PhRMA.
"PhRMA was involved in the survey in terms of helping to pay for it," coalition spokeswoman Kim Cochran said. "But that's about all they were involved in the survey."
There is much at stake in how the state plan handles its drug benefit. Altogether, the health plan, which also includes teachers and University System of Georgia Board of Regents employees, covers a third of the people in the state.
When the groups were all lumped together, under the supervision of the Department of Community Health, the hope was Medicaid care would be raised to the level of the other plans, said M.J. Collier Jr., the board chairman of the Georgia Academy of Family Physicians. Instead, the opposite has happened and the other plans are "more approaching the level of the Medicaid health care," Dr. Collier said.
The proton pump drugs, which act on parietal cells to reduce acid production, were easy targets because there are older, less effective drugs that treat acid reflux but do not relieve the associated burning sensation, Dr. Collier said.
"That's a quality of life no one should have to settle for," Dr. Collier said.
The state can counter with some big numbers - the drugs alone last fiscal year accounted for $41 million, or 6 percent, of its pharmacy budget, said Community Health spokesman Martin Smith. Many of the patients could be treated effectively with less expensive therapies but doctors are reaching for well-known expensive drugs, Mr. Smith said.
"It's a knee-jerk prescription," he said.
Drug costs have increased 25 percent a year and that has to stop, he said.
Prior authorization, though, has kept Augusta gastroenterologist Paul Webster or his staff on the phone for 25 minutes at a time, a big burden for doctors prescribing correctly.
"If I have to spend 25 minutes on every patient to get them their medication, I couldn't function," Dr. Webster said.
One reason the Georgia Department of Community Health began requiring prior authorization from the provider before filling the prescription for certain drugs is the enormous growth in the cost of prescription drugs. One class of drugs in particular, called proton pump inhibitors and used for treating acid reflux, is the focus of a fight between the state and provider groups.
In fiscal year 2001, those drugs:
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