Yet the idea isn't sitting well with legislative leaders, who have asked to be consulted before the department moves ahead - seemingly out-of-character for fiscally conservative Republicans. But House Speaker Greg Curtis isn't convinced a list will save millions of dollars, as claimed.
"I'm not sure they've built administrative costs into the mix. And we believe there has been a quiet commitment to [low-income] advocates that this money will go into expansion of other Medicaid programs," said the Sandy Republican. "They're just trading one program for another."
Judi Hillman, health policy analyst for the advocacy group Utah Issues, denies striking any deals with Medicaid administrators.
"I wish we had that kind of power and influence," says Hillman, who endorses the preferred-drug list as a "good way" to contain soaring prescription costs as long as it's crafted carefully to ensure patients aren't denied treatment.
Health department officials don't need legislative buy-in, but have agreed to brief lawmakers at a budget hearing in May. Republican Gov. Jon Huntsman Jr. has already given his blessing.
Preferred drug lists (PDLs), deployed by many private insurers and at least 29 states, indicate which drugs doctors and hospitals are allowed to prescribe without prior approval.
"We don't want to tell a physician that he or she cannot prescribe a certain drug," said Utah Medicaid Director Michael Diely, stressing that doctors can petition to override the list. "We're saying, in 90 percent of these drug classes it doesn't matter whether you use brand A or brand B."
Diely estimates a PDL, combined with a multistate bulk prescription purchasing bloc that Utah is also exploring, could save $12 million to $14 million a year. Much of that money goes back to the federal government.
Curtis suspects, however, those numbers don't reflect hidden administrative costs to the state and health providers in the form of added paperwork.
His fears are borne out by a 2003 review of Michigan's preferred drug list performed by the Kaiser Commission on Medicaid and the Uninsured. The study found that early glitches and mountains of red tape caused some Medicaid recipients to go without their medications, leading to expensive hospitalizations and lawsuits.
Utah lawmakers have rejected a PDL before, driven in part by fierce lobbying from pharmaceutical companies. During the 2004 election year, nine drug makers dumped $71,650 into mostly Republican campaigns in Utah, with $1,650 flowing to Curtis.
But Curtis says the pharmaceutical lobby hasn't influenced his opinion. "Depending on which drugs get pulled into the PDL, some companies might come out better," Curtis said.
Not all legislators are opposed to the proposal.
"People want to call it regulating and rationing," but states must find ways to contain spiraling Medicaid costs, said Senate human services chairman and dentist Allen Christensen, R-North Ogden.
Runaway drug prices and the growing number of uninsured and elderly have caused Medicaid growth to outpace the federal government's ability to fund it. Prescription drugs are Utah's fastest growing Medicaid expenditure, having more than doubled in five years to a projected $210 million in fiscal year 2005.
