More on the prescription drug bill

Last night, the House passed Senate Bill 5892 — the bill to cut costs in state-purchased health care programs by requiring more generics be substituted for name-brand drugs.

Background: In 2003, the Legislature created the “preferred drug list” for programs the state covers. The list is a compilation of the preferred — i.e. least expensive and equally effective — drugs in each class. It comes from Oregon Health and Sciences University and is OK’d by a board of pharmacists here before becoming official.

So, let’s say you’re on a state health care program — like Medicaid — and visit the doctor with a medical problem. The doctor prescribes a name-brand prescription treatment. Unless she writes “Dispense as written” on the prescription, the pharmacy must check the preferred drug list. If there’s a generic drug in the same class that’s preferred, they give you that drug instead. It saves the state millions of dollars.

One of the problems this bill seeks to address: There’s a small number of doctors who use the “Dispense as written” tool far more often than their peers. That costs the state a lot of money.

This bill would allow the state to talk to those doctors about their prescribing practices and limit their use of “dispense as written.”

It also allows the state to designate equally effective over-the-counter and generic drugs as “preferred” without approval by the board of pharmacists. What might that do? If you have heartburn and your doctor prescribes the latest name-brand prescription, you could go home with a box of over-the-counter Prilosec.

And: It requires that antipsychotic, antiretroviral, antiepileptic and other similar drugs not be substituted when a patient refills. That means mentally ill Medicaid patients, for example, will not have their prescriptions swapped.

Advocates of the bill say it will cut tens of millions of dollars off the state’s large prescription drug bill. But some last night — many Republicans and a number of Democrats — said they worried that swapping out what a doctor thinks is best for what the state thinks is cheapest isn’t safe.

The bill now heads to the Senate, who will decide if they agree with the changes made by the House.

Tags: prescription drugs