Politics influences flow of Medicaid dollars
Sunday, July 04, 2004
By SEAN REILLY
Washington Bureau
Few Alabamians have ever heard of Zyprexa. Through the Alabama Medicaid Agency, they've paid plenty for it.
A heavily promoted treatment for schizophrenia and bipolar disorder, Zyprexa costs more than $16 per pill wholesale. For Alabama Medicaid, the tab added up to some $25 million during fiscal 2003, more than that of any other prescription drug.
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Sepracor Inc. is a Massachusetts company that makes Xopenex, an anti-asthma treatment aimed at the children's market. Medicaid officials have refused to put Xopenex on the preferred drug list, citing the availability of cheaper alternatives that are just as good.
The company's quest to persuade the Legislature to exempt children's medications has so far fallen short, although lawmakers have made it easier for children to stay on brand-name drugs once Medicaid gives initial approval.
In an interview, Joe Turnham, a former chairman of the Alabama Democratic Party who lobbies for Sepracor, questioned whether an equally effective equivalent exists for Xopenex. Because asthmatic children tend to be poorer and disproportionately black, he added, "it becomes a justice issue as well."
Dr. Jennifer Allen Johnson, a Mobile pediatrician with a heavy load of Medicaid patients, said she sometimes prefers to prescribe Xopenex both because it is not as prone to push up children's heart rates and because harried parents don't have to administer it as often as the standard alternative.
Medicaid has never denied her requests to use Xopenex, but the paper work and coordination required by the approval process tie up a lot of staff time, Allen Johnson said.
While the financial pressures on the Medicaid agency make the policy understandable, she added, "when you're dealing with Medicaid patients, it's just a much sicker population."
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