Physicians switching to preferred Medicaid drugs: some hassles remain.(Practice Trends)

PORTLAND, ORE. -- It isn't always easy to prescribe drugs from a preferred list for Medicaid patients, but more physicians are making the effort, several speakers said at the annual conference of the National Academy for State Health Policy.

A number of Medicaid programs have established preferred drug lists (PDLs) as a way to contain pharmaceutical costs.

In Michigan, physician participation has been high since the state's phase-in of its PDL in March 2002, said Dr. Giovannino Perri, chief medical consultant for the state's department of community health.

At least 16% of the physicians in the state have switched some of their Medicaid prescribing to drugs on the state's preferred list. This shift indicates that "the preferred drugs have been increasingly prescribed for patients, a so-called sentinel effect of having the PDL," Dr. Perri said.

Similar results have been seen in Ohio, said Robyn Colby, chief of the Ohio Department of Job and Family Service's Bureau of Health Plan Policy In general, prior authorization is not required to prescribe preferred-list drugs. An initial spike in requests for authorization to prescribe nonpreferred drugs occurred when Ohio started its program, but that volume has since dropped, mostly because physicians have become comfortable with the choices on the preferred list, Ms. Colby said.

Changes to PDLs have caused concerns among physicians "who don't like to keep having to switch from one drug to another," said Paul Wallace-Brodeur, director of the Office of Vermont Health Access.

Physicians prefer to prescribe certain drugs for certain illnesses, Mr. Wallace-Brodeur said. They don't want to try something new--and they don't like the administrative hassles that come with the prior-authorization process.