FLORIDA MEDICAID PRIOR AUTHORIZATION FOR FOUR DRUG CATEGORIES

FLORIDA MEDICAID PRIOR AUTHORIZATION FOR FOUR DRUG CATEGORIES is scheduled to begin in late July or early August, with roughly 20 drugs currently headed for the prior authorization list. The program will require prior authorization to dispense certain transdermal nitroglycerin patches, antihistamines, nonsteroidal anti-inflammatory drugs and anti-anxiety agents/hypnotics made by companies that failed to provide Florida with the supplemental rebates the state was seeking. Florida notified manufacturers in February of its intent to seek supplemental rebates for products in four drug categories selected because they contain a wide variety of therapeutic options and high cost drugs with less expensive alternatives ("The Pink Sheet" Feb. 22, T&G-2). With the prod of prior approval unless a satisfactory rebate was obtained, Florida entered one-on- one negotiations with the manufacturers of about 44 drugs, hoping to obtain savings of $10-$25 mil. for its Medicaid drug program, which spends about $411 mil. annually. Negotiations with manufacturers are now all but finalized, and on June 4 the state published a draft administrative rule revision listing the products which will be on prior approval. That list contained 27 items, but as of June 15 the number had dropped to 21. A final rule will be published when the record closes to public comment following a June 28 public hearing. Prior authorization will begin 20 days after the state files for adoption of the rule. According to the June 4 draft rule, all transdermal nitroglycerin patches except brands made by 3M Pharmaceuticals, Searle and Warner Chilcott will be subject to prior approval. Antihistamines on the list are Sandoz' Tavist in 2.68 mg tablets; Marion Merrell Dow's Seldane; and Schering-Plough's recently approved Claritin, which will not go on prior approval until Oct. 15. In the anti-anxiety/hypnotic category, Upjohn's Xanax and Halcion are on the list, as well as Mead Johnson's BuSpar, Sandoz' Clozaril, Abbott's ProSom, Schering's Paxipam, Parke-Davis' Centrax and Searle's Ambien. Absent from the list are Janssen's antihistamine Hismanal and Wyeth-Ayerst's anti-anxiety agent Ativan. The rule lists 11 NSAIDS for prior approval, with no top- selling products absent. It also includes all enteral nutritional products and influenza vaccine for institutionalized recipients, "except when the manufacturer has entered into a rebate agreement with the Medicaid program." The additional rebates obtained did not reach Florida's goal, a state official said, but in many cases were deemed to be acceptable. A provider notice is being prepared to inform physicians and pharmacists of the new rule. Florida already has a prior authorization system in place for food supplements and Clozaril. Prior approval will not be used for any drug or biological for a period of six months after the date of approval, the draft rule states, and, except for the influenza vaccine, nutritional products and transdermal nitroglycerin patches, will "apply only to the innovator multiple-source drugs and single-source drugs listed herein which are marketed or distributed under an original new drug application." Medicaid recipients over the age of 21 will be limited to six prescriptions per month.