BY MARY ELLEN POWELL
DBJ Contributing Writer

It is not unusual for a state agency to look for ways to reduce costs and improve efficiency so when a pharmaceutical trade group offered to pay for a $25,000 study of the Mississippi Medicaid System, State Medicaid Director Rica Lewis-Payton took them up on that offer.
Mississippi Medicaid is looking for ways to reduce prescription costs and is considering cutbacks on the use of brand-name prescription drugs and an increase in the use of generics. And, though the plan to use less brand-name medications does not benefit pharmaceutical companies, the Pharmaceutical Research and Manufacturers of America funded the study conducted by Muse and Associates, a Washington-based consulting firm. The study is not directly related to the prescription savings plan but its findings have been helpful in looking for ways to provide cost-effective, beneficial health care to Medicaid prescribers.
“The study produced several recommendations,” says Payton. “It took some of the data out of Medicaid’s system and provided it back to us in information form. The study identified specific populations that may be designated for disease management and targeted case management.”
Muse and Associates released the study to Mississippi lawmakers that included information about the most expensive diseases treated under Mississippi Medicaid and details about drug expenses. The study recommended that Mississippi Medicaid examine prescription use among nursing home patients.
The study also stated that Mississippi Medicaid should pursue disease management programs. The Division of Medicaid (DOM) defines disease management programs as those designated to target specific patient populations with specific high-cost conditions to help achieve optimal health outcomes using the most cost-effective intervention. These disease management programs focus on specific disease populations rather than specific settings such as nursing homes.
“The implementation of disease management programs requires significant educational activities for health care providers about current clinical guidelines as well as patient education regarding the proper taking of medications and the use of equipment that can reduce possible complications,” explains Payton.
Payton points to diabetes, one of the prevalent diseases in our state, as an example of how educational programs on both the healthcare professional and patient sides can help to reduce complications. These programs are designed to insure that diabetics get health promotion and disease prevention information to prevent complications such as amputations, transplants, and dialysis.
At this point, the projected savings of the prescription plan are unclear as the DOM evaluates which parts of the plan will be implemented.
One of the proposed cost-saving methods that will be put into action by October 1, 2001, is the use of a Pharmacy Benefits Manager (PBM) services contractor. The additional personnel supplied by the PBM services contractor will help to augment the activities of the Drug Utilization Review system that is currently in place.
The new PBM services contractor will assist the DOM in-house staff of healthcare professionals as they process the medical necessity documentation submitted by prescribers that is required for prior approval for a small numbers of drugs and drug classes. The increased manpower is also expected to improve the level of health care delivered to beneficiaries.
As part of the expected increased services to prescribers, the DOM anticipates that education regarding the availability of generic or less costly but equally effective drug therapies will be available to Medicaid recipients. Mississippi Medicaid also aims to provide case management for prescribers to prevent over-medication, increased required prior approval of drugs, to insure the presence of medically justified diagnoses and the prevention of “off label” prescribing.
Thus far the reaction to the changes has been mixed, according to Payton. She says that the pharmaceutical community does not like preferred drug lists and the medical community does have concerns regarding the prior approval of medications.
“We have spent time with both parties and tried to assure them that the patients will get what they need, when they need it, but we can’t afford to give more than that” Payton says.
“We want to provide the most cost-effective therapy and want to use the less expensive alternative when it is equally effective and available. DBJ