According to the Kaiser Family Foundation (via Kaiser Health News) sixteen states are now limiting the number of prescription drugs each month. Seven of the states have made these adjustments in the past two years.
The limits vary across the country. For example, Mississippi has a limit of two brand-name drugs. In Arkansas adults are limited to up six drugs a month.
Doctors fear the state’s cost-cutting move could backfire on patients, who have to get state permission to go beyond the limit.
KHN: “We understand the state is trying to get its Medicaid budget under control,” says Dr. William Werner, president of the Illinois State Medical Society. “But our concern is it not be a hardship for patients and a hassle for doctors in the execution.”
States with Medicaid drug limits are Alabama, Arkansas, California, Kansas, Kentucky, Illinois, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Utah and West Virginia.
KHN: Doctors in these states are concerned that some of their patients will not be able to find generic replacement drugs. Jarod Speer, a family doctor in Alabama is concerned that his patients with asthma and other lung diseases face limited options for medications that are not available in generic form.
Additionally, thirteen states are cutting Medicaid to balance their budgets. Medicaid services will be trimmed through reduction of benefits, eligibility, paying health providers. This happens even as the Affordable Health Care Act prepares to expand coverage for as many as 17 million people.
This year’s reductions come on the heels of more extensive cuts last year, threatening to limit access for additional millions.
KHN: “With more people on Medicaid, states will have to continue to ratchet down payments and limit services,” says Nina Owcharenko, director of the center for health policy studies at the conservative Heritage Foundation.
Some worry the cuts to doctors and hospitals could make it more difficult to expand the state-federal program in 2014, as called for by the federal health law. Providers may be unwilling to accept new Medicaid patients due to the reduced payments from the states.
Health Care Reform is necessary. But a review of these cuts should bring up many questions about the Affordable Health Care Act.
Detail of Provider, Benefit or Eligibility Cuts
|Cut fees to doctors and dentists by 10 percent. Eliminated eyeglass coverage; limited brand name drugs for most adults to one drug a month (exempted are long-term-care patients and HIV and psychiatric drugs) through July 31, after which the limit will be four brand-name drugs a month; cut routine eye exams from once every two years to once every three.|
|Cut payments to private hospitals by $150 million; froze rates for payments to nursing homes; cut fees to clinical laboratories by 10 percent. Added $15 co-pay for non-emergency ER use and $1 and $3 co-pays for certain drugs. (Source: California 2012-13 State Budget)|
|Cut nursing home rates by 1.5 percent. Limited orthodontics coverage, added some co-pays and enrollment fees to its Children’s Health Insurance Program based on family income. (Source: Colo. Dept. of Health Care Policy & Financing)|
|Preparing to seek federal approval to eliminate coverage for adults with assets exceeding $10,000 (excludes home and one car), and to count parental income and assets for adult children aged 19 to 25 who live with their parents.|
|Cut hospital rates by 5.6 percent, and nursing home rates by 1.3 percent. Seeking federal approval to limit home health visits for non-pregnant adults to no more than three per day, primary care visits to no more than two per month and ER coverage to a maximum of six visits per year.|
|Reduced eligibility for non-pregnant adults from 200 percent of poverty level ($46,100 for family of four) to 133 percent ($30,656 for family of four)..|
|Cut fees to health providers, except physicians and dentists, by 2.7 percent. Cut payments to non-safety net hospitals by 3.5 percent. Reduced parents’ eligibility from 185 percent of federal poverty level ($42,642 for family of four) to 133 percent ($30,656 for family of four) to eliminate more than 25,000 people from the program; increased co-pays for drugs; limited prescriptions to four a month, with state permission needed for more; added a $3.65 fee for nonemergency ER use; eliminated chiropractic coverage and regular dental care for adults. Pregnant women are exempt from co-pays. (Source: Ill. Dept. of Healthcare & Family Services)|
|Cut fees to doctors (primary care excluded) by 3.4 percent, cut fees to dentists by 3.7 percent, cut mental health providers by 1.9 percent and cut fees to dialysis centers by 3.7 percent.|
|Planning to seek federal approval to eliminate coverage for 19- and 20-year-olds and to reduce eligibility for parents from 200 percent of poverty level ($46,100 for family of four) to 100 percent of poverty level (23,050 for family of four). Also eliminated coverage for ambulatory surgery centers, sexually transmitted disease clinics and coverage of smoking cessation products, except for pregnant women.|
|Cut fees to nursing homes by 2 percent and to hospitals by 1 percent.|
|Cut payments to hospitals by $160 million.|
|Added a $1,000 annual limit for non-emergency dental services for adults. Implemented a $1 co-pay for generic drugs and increased co-pays for brand name drugs to $3.30.|
|Eliminated coverage for non-pregnant adults over 133 percent of the federal poverty level ($30,656 for family of four) if they are offered affordable coverage by their employers; added or increased monthly premiums for some non-pregnant adults; eliminated presumptive eligibility for adults. (Sources: Wis. Dept. Of Health Services news release and update)|
|Graph reprinted with permission from Kaiser Health News|