Utah's Medicaid patients would be steered toward lower-cost prescriptions, but could seek approval for others. At least 26 states have restricted Medicaid reimbursement to similar lists, and most private insurers do the same. A resolution giving the state Health Department permission to steer Medicaid patients to lower-cost prescriptions was tabled by a legislative committee on Wednesday - but not before a ranking senator scolded its sponsor for reopening a debate deemed closed by Republican leaders.

The idea of a Medicaid preferred drug list (PDL), which would encourage use of discounted drugs and require approval for others, was rejected in July by the legislative budget committee under fierce lobbying by the pharmaceutical industry.

Concerned by the lack of public input, West Jordan Republican Rep. Steve Mascaro sponsored a resolution urging health officials to go ahead and run a limited test of such a list.

"This is a program that has the potential to lower Medicaid costs. It's a policy decision that deserves attention and debate from the full body of the Legislature," Mascaro said.

He alleged the July vote was timed to guarantee the proposal's failure; that had a Democrat not left the hearing early to attend to family business, the outcome may have been different.

Finding Mascaro's remarks "offensive," Senate Majority Leader Pete Knudson declared in a raised voice: "This resolution is out of order."

The Brigham City Republican said budget leaders have agreed to revisit the PDL if Health Director David Sundwall supplies proof that it won't prevent medically fragile Medicaid patients from getting the medicines they need.

"I don't want to imply that you're circumventing a process that is ongoing. But to interject legislation . . . I find very disconcerting," said Knudson. "This issue should remain with Executive Appropriations."

Knudson contended Sundwall could adopt the drug list without legislative approval. Utah law requires that health officials only report Medicaid changes to the Legislature.

Debate on legislative process overshadowed discussion of the merits of a PDL, and may have been a waste of time.

Though he risks retaliation by budget leaders, Sundwall said he will continue to lobby for a PDL - and if he fails to win them over, he said, "the governor and I will just go ahead and do it."

"The data is clear on this. It would be irresponsible for us not to try and achieve these savings," said Sundwall. "I have confidence that this Legislature won't link this to the budget, because what we do is so important."

Sundwall pitched a pilot drug list as capable of saving $5 million, an estimate based on limiting the program to two drug classes - acid reflux and cholesterol-lowering medicines.

Also on Wednesday, Sundwall pledged that as long as he commands the Health Department, drugs used for treating mental illness will be not be limited by a list. Aside from the pharmaceutical industry, advocates for the mentally ill are the only group opposing a PDL.