Such is the logic behind the preferred drug list being pitched by Gov. Jon Huntsman Jr. as Utah's best option for curtailing Medicaid spending. But the governor has some lobbying to do if he plans to convince lawmakers.

Legislative leaders at Tuesday's budget hearing grilled state health department officials on the purported benefits of generally restricting Medicaid reimbursement to a pre-determined list of drugs.

Some fear it would delay patients' getting the medications they need. Others say the estimated $12 million to $14 million in savings might be used to expand other Medicaid benefits, such as permanently restoring dental coverage. But ultimately, opposition stemmed from a reluctance to regulate the pharmaceutical industry.

The fastest growing slice of Utah's budget pie is Medicaid, and the fastest growing Medicaid expenditure is prescription drugs. Driving costs are bulging Medicaid rolls, higher-priced therapies and a growing appetite for the latest, greatest remedies.

State Health Department Director David Sundwall testified Tuesday that the number of people who need Medicaid isn't likely to shrink - so to save money, states must pursue other strategies.

Sundwall said preferred drug lists give states leverage to join purchasing pools that negotiate manufacturer rebates, creating downward pressure on the pharmaceutical market.

But House Speaker Greg Curtis says it's not the government's job to "control the market." The Sandy Republican suggested a better way to slow runaway costs is to educate doctors or boost Medicaid drug co-pays.

"If a patient pays a percentage of a prescription, it seems to me that he or she will be less likely to buy the most expensive drug," Curtis said.

Sundwall fears such an approach wouldn't work, because some Medicaid beneficiaries, such as children and pregnant women, are exempted from co-pays. And he said any educational campaign aimed at encouraging safe, cost-effective prescription practices would pale in comparison to the advertising budgets of the nation's drug makers.

Medicaid director Michael Diely promised the Legislature would have the final say over how to spend any savings that result from a preferred drug list. Representatives from the pharmaceutical industry will offer their views at a meeting next month.

The plan is backed by the governor, Utah Medical Association, pharmacists and advocates for the elderly, poor and disabled. If given the legislative stamp of approval, Diely says, the state would start slowly with three of five possible drug categories: acid reducers, sedatives, cholesterol lowering and anti-incontinence drugs and anti-inflammatories. He estimates the list would cost about $150,000 to implement.