Colorado Medicaid plan imposes low-income prescription limit
Associated Press
Effective May 2, and in an effort to cut costs, Colorado began limiting low-income patients to eight prescription drugs at a time. Some doctors say the plan could push physicians to stop accepting Medicaid patients.
The plan is expected to save Colorado's Medicaid program $6.6 million a year, and doctors who believe they need to prescribe more than eight drugs to a Medicaid patient first will have to call a toll-free number for approval.
Six types of drugs won't count toward the eight prescriptions: chemotherapy, contraceptives, anti-psychotics, prenatal nutrition therapy, and drugs for diabetes and AIDS.
A doctor with the Weld County Department of Public Health told the Associated Press there are other illnesses which require several prescriptions, including emphysema, high cholesterol, and congestive heart failure. Some doctors say the added step of calling for approval wastes time they can't spare.
On April 1, Colorado implemented the program in 18 of 63 counties and
didn’t require legislative approval. Doctors learned of the policy in a note at the bottom of their March billing statements.
A primary care doctor with an urban Denver neighborhood practice and sees a lot of Medicaid patients termed the plan "just ridiculous" and was advising patients to put their eight most expensive drugs on the Medicaid list and try to find generic drugs for other prescriptions. He said he had asked some patients to pay for expensive medicine on their own because he doesn't have time to call for approval.
Approximately 320,000 low-income residents participate in Colorado's Medicaid program, and 7,432 take more than eight prescriptions. That figure includes 1,706 who are one drug over the limit, according to state records.