A closer look at Montana Medicaid drug program: Are taxpayers pa - KXLF.com | Continuous News | Butte, Montana

A closer look at Montana Medicaid drug program: Are taxpayers paying too much?

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Prescription drugs are a cost for most Montanans, but did you know tax dollars are also being used to buy them?

A former member of the Medicaid Board says taxpayers need to take a closer look at costs to make sure Montana is getting a good deal.

“In the state fiscal year 2016, we spent about $106 million,” said Duane Preshinger, administrator of health resources division of the Department of Health and Human Services.

But Tony King, a former member of the Medicaid Board and now a pharmacy manager says that figure came with other costs.

“We are carrying (an) extra burden, extra inventory costs and not seeing anything extra for having to carry a product that we normally wouldn’t dispense to the public,” said King.

Montana Medicaid has a mandatory generic policy unless there is a substantial saving to the state through a special rebate program provided to Medicaid for brand-name drugs under federal law - thus making it more cost-effective for the state.

“It looks at the best value, overall value to the state and for some of the generic (drugs), costs could be higher than other drugs,” said Preshinger. “But though how Montana uses its rebate program, it’s to provide overall savings to the Medicaid program.”

But a closer look found out that’s not the case.

For example, Abilify, which a brand-name drug, has a generic alternative that is much cheaper. Yet DPHHS and Medicaid wish to stand by the rebate for brand-name products, saying it is cheaper.

There are 8 brand-name drugs the state uses that have generic equivalents.

Focalin does have some cost savings from the approximate 52 percent rebate, however, Adderal Extended Release (XR) is still significantly higher cost for the brand after the rebate than the generic would be.

Abilify, used for the treatment of bipolar and schizophrenia - after the rebate, it’s still more than 500 percent more expensive than the less-expensive generic version.

When DPHHS was shown the data, they refused to comment.

Independent pharmacy owners are frustrated by this.

“Bottom line, we are here for the patient,” said Brian Westberg, owner of Western Drug in Bozeman. “We want to provide them what they need. What the doctor ordered, but also at the lowest possible costs. Again, it’s frustrating to see two bottles, side-by-side, with a 90 percent cost difference.”

The contract that DPHHS has with Medicaid will be renegotiated in April.

Until then taxpayers will continue to pay more for some Medicaid drugs.

There are more than 207,000 Medicaid patients in Montana and taxpayers are spending $106 million a year toward the Medicaid drug program.

Montana Medicaid Preferred Drug List (PDL) 

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