By Joseph O. “Joe” Dean Jr., Ph.D., former dean of the McWhorter School of Pharmacy at Samford University.
As a retired pharmacist and pharmacy educator, I am extremely troubled by the current issues regarding Alabama Medicaid and some of the proposals for addressing them.
A recent report from the Public Affairs Research Council of Alabama sheds much-needed light on the fallacies of certain cost-saving proposals – specifically, the idea of balancing the Medicaid budget by cutting adults’ prescription drug coverage.
You might as well try to balance the education budget by eliminating the first- and second-grade.
Eliminating drug coverage would indeed save money upfront. But it would ultimately cost much, much more.
The reason is simple: When chronically ill people don’t take their medicine, they get sick. They are far more likely to end up in emergency rooms and hospitals. They are more likely to require expensive procedures, surgeries, and care.
Are there legitimate concerns and horror stories about the price of some medication? Absolutely. But as a rule, when medication is prescribed and taken properly, it is one of the most cost-effective ways to keep people healthy and reduce other spending for health care.
This has been established by research and confirmed by real-life experience among people who have diabetes, high cholesterol, high blood pressure, COPD, HIV, mental illness, and other chronic conditions.
In the federal government, the nonpartisan Congressional Budget Office estimates that total program costs for Medicare fall 0.2 percent for every 1 percent increase in recipients’ utilization of medicine.
One study involving just eight medical conditions linked the Medicare drug program to 77,000 fewer annual hospital admissions – a 4 percent reduction.
Alabama has experienced similar benefits from proper use of medication in the state’s Medicaid program.
Some examples were included in a recent report from the Public Affairs Research Council of Alabama, a think tank based at Samford University.
Discussing the Alabama Medicaid Agency’s past experiments with managed care, PARCA shared the story of one program in east Alabama that significantly reduced hospital and emergency room expenses by keeping patients on track with their primary doctors and their medication.
One real-life example involved a 54-year-old man who had not been taking his medication for diabetes and heart disease — and who, not surprisingly, had regularly become ill and gone to the hospital.
Caseworkers provided the patient with education and encouragement to take his medication as prescribed, and they stayed in close contact with him about monitoring his blood sugar. As a result, his health improved, and the cost of his care dropped sharply – from $19,546 the year before he began receiving these services, to $3,854 in the year after. He did not go to the emergency room or require hospitalization the entire year, according to the PARCA report.
Medications are a key part of keeping health costs down. But they don’t work if people don’t take them. People who lose access to prescription drugs will pay a price with health, and we will pay a price for their health care.
One idea under consideration is limiting patients’ choice of pharmacy providers, which would create access issues and be another barrier to prescription drugs for some Medicaid patients. In addition to limiting access, this proposal could hurt patients by breaking down their established relationships with pharmacists. Good pharmacist/patient relationships based on trust and respect lead to better health outcomes.
Again, we must look at the long-term consequences in any attempt to save money in the short term.
I can sympathize with Alabama leaders’ quandary as they try to meet many so many needs with limited resources, and I understand there’s no easy fix from a political standpoint.
But in trying to find $85 million in spending cuts, Medicaid can’t sacrifice the very services that have the potential to save money later.
Cutting prescription drug access will hurt patients and it will not help our state.
We need to fix our problem, not create 10 more problems down the line. If our goal is to contain Medicaid costs, cutting drug coverage is the last thing we can afford to do.