Worry over new Medicaid drug-list program

The fear: getting proper medicine will be harder

Myung Oak Kim, Rocky Mountain News

Saturday, September 15, 2007

Nita Bradford knows firsthand how the right medication can change the life of someone who is mentally ill.

Her son, who suffers from bipolar disorder, barely functioned for 20 years while taking his old drug. Six years ago, he began taking a new drug that helped him so much that he now operates a successful tree-trimming business, Bradford said.

Bradford, a retired schoolteacher and mental health advocate from Lakewood, wants others with mental illness to have easy access to the right medication so they can lead productive lives.

She fears the state will hamper that access through its new preferred drug list program for Medicaid patients. She and about 20 others expressed those concerns Friday at a meeting of the Medical Services Board, which is setting rules for the system.

If their medications are placed on the nonpreferred-drug list, "It would put up a wall (for the mentally disabled) and would deny them the opportunity to reach their potential," Bradford said.

Members of the Medical Services Board and staffers at the Colorado Department of Health Care Policy & Financing tried to ease those concerns. They said the program won't stop patients from getting the drugs they need - and should help patients get better care. They said it might be possible for individual patients to be exempted from the requirements placed on nonpreferred drugs.

The state began developing a preferred drug list program for its nearly 400,000 Medicaid patients as the result of an executive order signed by Gov. Bill Ritter in January 2007.

A preferred-drug list is expected to save the state money. Medicaid patients who are prescribed drugs on the nonpreferred list must get special permission from a committee to get those medications.

Patients won't see any changes until early 2008, when committees are expected to begin placing drugs on the preferred or nonpreferred lists. The executive director of Health Care Policy & Financing will have final say in those decisions.

At Friday's meeting, the board gave initial approval to a framework for the program. It also approved the exemption of six categories of drugs - including those used to treat patients with psychosis, HIV/AIDS and cancer - from consideration for the preferred-drug list until 2009. That means those drugs cannot be subject to restrictions until at least early 2009.

These rules are not final. The board must approve them again next month before they take effect.

Advocates representing the AARP testified in favor of a preferred-drug list without exempted categories.

Advocates for mentally and developmentally disabled patients disagreed, saying the board didn't go far enough with its exemptions.

"We're not happy at all," said Chris Habgood of Mental Health America of Colorado. "We feel that they have not done an adequate job of protecting the most vulnerable populations."

kimm@RockyMountainNews.com or 303-954-2361