States Enact Prescription-drug Limits on Medicaid Patients

By:  Brian Koenig
08/01/2012
       
States Enact Prescription-drug Limits on Medicaid Patients

As President Obama’s landmark healthcare law penetrates deeper into implementation, signs of medical rationing are sprouting, as 16 states have enacted a limit on the number prescription drugs they will insure for Medicaid recipients.

As President Obama’s landmark healthcare law penetrates deeper into implementation, signs of medical rationing are sprouting, as 16 states have enacted a limit on the number prescription drugs they will insure for Medicaid recipients. The latest state to institute a cap under the state-federal health insurance program is Illinois, which is placing its limit at four drugs per month.

Medicaid, a federal health program that works in conjunction with state governments, is a chief component of the Affordable Care Act — also known as ObamaCare — because the law boosts the income cap on eligibility, leading to a spike in the number of people covered by the program. Considering the expanded coverage, along with a federal premium subsidy for Americans earning up to 400 percent of the poverty rate, a significantly larger percentage of the population will be dependent on the government for their healthcare needs.

The drug limits vary from state to state, as Mississippi has set a cap of two brand-name drugs per month, while Arkansas adults are capped at six drugs per month. Up until June, Alabama had the country’s most frugal Medicaid drug limit after restricting patients to only one brand-name drug a month, with HIV and psychiatric drugs excluded. Beginning August 1, however, the state will revert to its previous four-drug limit, after the rule salvaged more funding than expected and the state was awarded money from a settlement with a pharmaceutical firm.

Doctors and other critics worry the cost-cutting measures could be detrimental to patients, who typically must receive a state exemption in order to go beyond the purported limit. "We understand the state is trying to get its Medicaid budget under control," asserts Dr. William Werner, president of the Illinois State Medical Society. "But our concern is it not be a hardship for patients and a hassle for doctors in the execution."

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