Clip files / Local news from the states
This column features selected short items about state health care policy.
Deal between Florida legislature and Pfizer becomes public and then fizzles
TALLAHASSEE, FL—After secret negotiations with the nation’s largest drug maker became public, state health officials backed off key provisions of a deal assuring the company of millions in future sales to Florida’s Medicaid program.
Instead, Pfizer Inc. will have to abide by the same review process required of other drug companies competing to have their drugs included on a list of Medicaid-approved medications.
The negotiations evolved as the state attempts to cut Medicaid drugs costs. A bill expected to become law July 1 is intended to save the state more than $200 million by requiring drug companies to provide discounts in the form of cash rebates or other services.
The Sun-Sentinel of Fort Lauderdale recently revealed terms of a confidential proposed agreement with the Agency for Health Care Administration (AHCA) in which Pfizer agreed to provide certain health services instead of paying cash rebates. In return, AHCA would have assured that 23 of Pfizer’s drugs were automatically on the list, called a formulary, without going through a review by a committee of medical experts.
—Sun-Sentinel, Fort Lauderdale, May 17
In an attempt to save money, Louisiana officials seek to limit Medicaid prescriptions
BATON ROUGE, LA—A bill that would limit the types of medications available to 736,000 of Louisiana’s poor, and in turn save the state millions of dollars, passed the Senate after more than a decade of debate in the legislature.
Fueled by support from the state Medical Society and overcoming fierce opposition from a phalanx of pharmaceutical industry lobbyists from across the country, the Medicaid pharmacy measure passed 22-15 in the Senate. It now moves to the House.
Senate Bill 502 by Sen. Tom Schedler (R-Slidell) seeks to limit rapidly rising costs in the state’s Medicaid pharmacy program by implementing a system used by most of the nation’s private health insurers.
Medicaid patients are currently entitled to a virtually unlimited list of medications for up to $3 per prescription.
A list devised largely by doctors and pharmacologists would dictate which types of drugs, generic and brand-name alike, would be readily available to Medicaid recipients, unless their physicians obtain prior approval from the state to use another drug.
—Times-Picayune, New Orleans, May 18
New life granted to Tennessee agency that controls clinics and hospitals
NASHVILLE, TN—Senators have compromised and agreed to extend for two years the life of a state agency that controls health clinics and hospitals.
Gov. Don Sundquist has wanted to put the Health Facilities Commission in a one-year wind-down, while many senators wanted to give the commission the typical four-year renewal.
’We tried to find good common ground to help improve the commission,’’ said Sen. Bill Clabough (R-Maryville), who offered the compromise amendment. The legislation also creates an eight-member study committee. The Senate vote was 27-2 with one member abstaining.
The Health Facilities Commission was created to keep the costs of health care down by limiting excess clinic and hospital construction, as well as services and equipment purchases.
Sundquist has been dismayed by some commission decisions favorable to facilities that do not take TennCare patients. Sen. Curtis Person (R-Memphis) opposed the bill, saying Sundquist wants to reform the commission and does not think incentive will be there without more time pressure.
—The Tennessean, May 18
Feds say North Carolina filed claims before eligibility was determined
WASHINGTON, DC—An audit by the U.S. Department of Health and Human Services says North Carolina misused $48 million in child care payments and is recommending that the state return the money.
The audit involved federal foster care and child care grants made to the state from 1993 until 1997. Federal auditors found that state officials failed to determine whether programs were eligible to receive reimbursements before submitting claims, according to audit documents.
"Our review indicated that the state was reimbursed over $48 million for unallowable child care payments," said a letter from Michael Mangano, an acting inspector general for the federal agency.
The letter, sent to state Health and Human Services official Diann Dawson, recommended both repayment of the money and that state officials better monitor consultants who submit claims.
The audit documents also indicate that a federal review into child care reimbursements after October 1997 is continuing.
State officials called the audit process "critically flawed" and are fighting efforts to force the return of the money.
Debbie Crane, a spokeswoman for the state Department of Health and Human Services, said the dispute is largely over the interpretation of federal rules.
—Associated Press, May 18
Vermont considers hiking cigarette prices to help lower costs for prescription drugs
MONTPELIER, VT—A Senate committee is expected to examine whether to hike the tax on cigarettes as much as 67 cents a pack to help pay for health care programs.
Sen. Cheryl Rivers (D-Windsor), the chairwoman of the Senate Finance Committee, rolled out a proposal to amend a bill aimed at lowering high prescription drug prices with a cigarette tax.
The House had passed a bill that relied on a list restricting the drugs available to Vermonters on state-run health programs and using the savings to aid those with extremely high drug bills. But the Senate Health and Welfare Committee scaled back that plan, tossing out the cost containment and catastrophic pharmacy assistance provisions.
Rivers’ tentative plan would use some of the money generated by the cigarette tax hike — about $25 million a year by some estimates — to pay for the catastrophic pharmacy plan, which would get $2 million.
—Rutland (VT) Herald, May 21
Maine officials may ask drug makers to disclose more about promo costs
AUGUSTA, ME—Hoping to put more pressure on prescription drug companies to make their prices more affordable, the Maine House has endorsed a bill requiring drug firms to disclose more about their promotional costs.
A bill that received preliminary approval by a 76-57 vote would oblige companies that manufacture or label drugs sold in Maine to submit annual reports on how much they spend marketing, advertising, and promoting their products.
Much of the information would be available to the public as a way to control costs that are said to inflate the cost of prescription medicines.
Rep. Nancy Sullivan said she and other politicians must disclose where they get campaign money and how they spend it, and "I think the pharmaceutical companies need to be held to the same standard."
"We’re asking here for companies [to] put out your information, disclose it, and let public perception decide if you’re spending your money wisely," the Biddeford Democrat said during a lengthy debate.
Supporters also contended that consumers who are targeted by ads ask their doctors for certain medicines even though less-expensive alternatives are available.
—Associated Press, May 21
Rates for health care along Mexican border take front stage for Texas state legislature
AUSTIN, TX—Lawmakers continue overhauling the state’s Medicaid program with bills ranging from making it easier for children to enroll to studying rate disparities on the border.The Texas House gave preliminary approval, 88-45, to a proposal by Rep. Norma Chavez (D-El Paso) to study whether the state pays too little for Medicaid services along the Texas-Mexico border.
"What we’re trying to deal with, members, is the disparity issue," Ms. Chavez said.
Doctors practicing in the region have said they are insufficiently reimbursed when compared with physicians in other parts of the state.
Supporters say increasing reimbursement rates will encourage physicians to practice along the border, where a high number of uninsured patients are treated by few providers. Opponents say raising border rates would create a subsidy at the expense of other areas.
—Associated Press, May 22
Alabama told it owes millions from improper payments from the feds
WASHINGTON, DC—The Alabama Medicaid Agency should refund the federal government at least $168 million for improperly collected payments over the last four years, according to a review by the inspector general for the Health Care Financing Administration (HCFA).
Auditors concluded that state officials sidestepped their own regulations in seeking to shake loose more matching money from Washington. Between fiscal 1997 and 2000, the report states, Alabama Medicaid drew down $168.3 million in federal funds to which it was not entitled. The inspector general recommends that the state return the entire amount to HCFA.
It is not certain, however, that federal officials will adopt the recommendation. Under a best-case scenario, such a move would be likely to trigger years of legal wrangling. At worst, it could wreck the state’s already wobbly finances and imperil health care for tens of thousands of Alabamians.
A HCFA spokesman said the agency was reviewing the inspector general’s report and hoped to make a decision later this year. At Alabama Medicaid, which disputes owing any money, spokeswoman Mary Finch said the agency is preparing a response to the findings.
"Once we know what action, if any, HCFA is going to take, then we’ll work with our state and congressional representatives," Ms. Finch said.
— Mobile (AL) Register, May 22
DOA: Tennessee legislature puts aside patients’ bill of rights, for now
NASHVILLE, TN—The push to bring a patients’ bill of rights to Tennessee may be dead for the year under pressure from the insurance industry.
The House Budget subcommittee voted to delay consideration until after the state budget is passed, an unusual move since the legislation does not have any costs attached and would not affect the budget.
’It probably is dead, but I’m not sure,’’ said Rep. Randy Rinks (D-Savannah), House Democratic Caucus chairman and a member of the subcommittee. ’The trouble was trying to get agreement across the board with all the parties . . . the insurance industry and business groups.’’
The bill would allow Tennesseans who think they have been denied necessary medical care by their health insurance plans to appeal under a streamlined review process and then have the option to sue.
’It’s not good news for any bill that does good for people of Tennessee to be put behind the budget,’’ said Rep. Kim McMillan (D-Clarksville), the House sponsor.
— The Tennessean, May 24
Wisconsin, fighting to close gap in child care funding, passes new compromises
MADISON, WI—The Legislature’s budget committee unanimously approved a measure to fund a projected $95.1 million child care subsidy shortfall in the state’s welfare program, helping to close the budget gap in the process.
The $95.1 million was part of a $761 million gap in the budget the Joint Finance Committee is trying to eliminate. By funding the shortfall through a combination of new state money, federal dollars and cuts — along with other provisions — the committee has reduced the budget gap to about $650 million.
"It probably, at least for a while, could be the largest single reduction in the bottom line that we’ll see," said Rep. John Gard (R-Peshtigo). "This is a very significant step for this committee to actually balancing the budget."
Gard worked out a compromise to fund child care in the state’s welfare-to-work program, W-2, with Democratic Sens. Gwendolynne Moore of Milwaukee and Kimberly Plache of Racine.
The provision includes $10 million in new state funding, about $36 million in federal funds, and almost $50 million in cuts. Mr. Gard said $8 million of the reductions come through savings in administrative costs.
—Associated Press, May 23
Church and state clash in Oregon over insurers and contraceptives
SALEM, OR—A House committee has made little progress on a bill that would require insurers to cover contraceptives.
At least 19 amendments to the bill have been proposed to exempt religious organizations that oppose birth control.
Debate has centered on how broad that exemption should be. Oregon Catholic Charities, which asked for the "conscience clause," wants the exemption to apply to any employer, public, or private, citing a religious objection.
Gayle Atteberry, executive director of Oregon Right to Life, said she does not want to be required to provide birth control to her employees.
Ms. Atteberry said she believes birth control methods that work by preventing implantation are equivalent to abortion because life begins at conception, not implantation.
Backers want the exemption to apply only to nonprofit organizations whose core service is religious. "Anyone could declare that they have religious tenets," said Rep. Cherryl Walker (R-Murphy).
—Statesman Journal, May 25
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