TRIPLICATE Rx REG SAVED NEW YORK MEDICAID $25 MIL

TRIPLICATE Rx REG SAVED NEW YORK MEDICAID $25 MIL in benzodiazepine expenditures in 1990 and $ 37 mil. during the period 1989-1990, according to a May 15 memorandum by the state's Social Services Department. The memo, written by the department's Assistant Pharmacy Consultant Karen Rocco, reports that "there was over $ 37 mil. cost avoidance to the addition of benzodiazepines to drugs that must be prescribed on triplicate prescriptions." Addressed to the department's Assistant Commissioner-Medical Assistance Division Judy Meagher, the memo reports on New York Medicaid's analysis of the effect of the regulation during the first two years it has been operational. The regulation added benzodiazepines to the list of controlled substances requiring triplicate prescription forms in New York State. New York Medicaid data show that the number of benzodiazepine claims paid by the state was 1.6 mil. in 1988 and dropped to 633,194 in 1989 and to 480,397 in 1990. Expenditures paid by the state for benzodiazepines plummeted from $ 22.7 mil. in 1988 to $ 11.6 mil in 1989 and rose only slightly to $ 13.1 mil. in 1990. New York attributed the lower benzodiazepine expenditures in 1989-1990 to the triplicate prescription regulation. If the number of claims had remained constant at 1988 levels, the state projected that 1989 expenditures would have risen from $ 22.7 mil. in 1988 to $ 27.7 mil. in 1989 and to $ 40.4 mil. in 1990. The memo notes that the projection "was calculated by multiplying the average cost per prescription for a particular agent during that year by the number of 1988 prescriptions for that agent." By subtracting the actual state Medicaid expenditures in 1989 and 1990 from the projected costs, the state calculated savings from the triplicate program of $ 16 mil. in 1989 and $ 27.3 mil. in 1990. A moderating effect on savings was caused by an increase in claims for other anxiolytics and hypnotics with the drop in benzodiazepine prescriptions. Claims for drugs in the "other" category -- which include buspirone, hydroxyzine, meprobamate, phenobarbital, chloral hydrate, talbutal and mephobarbital - totaled 393,250 in 1988, 581,892 in 1989 and 501,360 in 1990. Expenditures for non-benzodiazepine anxiolytics and hypnotics increased from $ 4.5 mil. in 1988 to $ 8.5 mil. in 1989 and dipped slightly to $ 8.2 mil. in 1990. Without the triplicate program, the memo estimates, costs would have been lower: $ 4.7 mil. in 1989 and $ 6 mil. in 1990. Consequently, the triplicate regulation caused an increase in New York Medicaid expenditures for non-benzodiazepine anxiolytics of $ 3.8 mil. in 1989 and of $ 2.2 mil. in 1990. By subtracting the projected increase in expenditures for other drugs from the projected savings on expenditures for benzodiazepines, the state realized a "net cost avoidance" of $ 12.2 mil. in 1989 and $ 25.1 mil. in 1990. Programs to monitor prescriptions of controlled drugs were reviewed at a May 30-June 1 conference convened by the National Institute of Drug Abuse. Even before that conference got under way, however, Rep. Stark (D-Calif.), who is developing an electronic prescription tracing proposal, questioned its objectivity. In a May 23 letter to NIDA Director Charles Schuster, Stark asserted: "I suspect the pressure from the pharmaceutical drug industry on NIDA will be too much, and NIDA will eventually publish an official document opposed to both multiple-copy prescription programs and electronic data transfer monitoring programs." Contending that "almost all the NIDA seminar participants opposed to [multiple-copy prescription programs] . . . have a long history of taking substantial amounts of money from a few pharmaceutical drug companies," Stark urged that speakers disclose relationships with industry or with law enforcement groups. Adding that California, Illinois and New York have had multiple-copy programs in place for two decades or more, he also asked why it has taken "NIDA until 1991 . . . to only 'study' the issue?"