Speakers Say Incentives Needed For Generics, Also Opiate Abuse A Problem

Arkansas pharmacists are reimbursed $3 less for dispensing generics than they are for brand-name drugs, creating a disincentive to sell them, Mark Riley, executive vice president of the Arkansas Pharmacists Association, told members of the Health Reform Legislative Task Force Wednesday.

Riley said that 85% of all prescriptions filled in Arkansas are generics, and lower reimbursement rates have caused more than 90% of pharmacies to change their operations.

But the situation is more common among private insurers than Medicaid. In fact, all but two of the top 25 drugs on the state’s preferred drug list, based on claims, are cheaper when bought under the brand name than as a generic, said Jason Derden, Pharm.D., program administrator with the Arkansas Medicaid Pharmacy Program. Derden said the state can work out deals with brand name manufacturers that aren’t available with generics.

The preferred drug list includes the drugs that are considered most effective for treating a disease.

Riley told legislators that pharmacists are well-positioned to provide patient-centered care and should be considered for other forms of paid services, including face-to-face appointments that would help patients adhere to their drug regimens. Anne Winter, CVS Health’s senior director, Medicaid, later told legislators that an additional $656 spent on diabetes drug adherence resulted in health savings of $5,227.

Dwight Davis, Pharm. D., director of the Evidence-Based Prescription Drug Program at the UAMS College of Pharmacy, told legislators that costs for the state’s Employee Benefits Division prescription drugs program fell $28 million between 2013 and 2014 but won’t fall that much again. He said costs for prescription drugs are “choking” the system, and that prices are rising – for certain drugs, very quickly. Costs of Humulin, or regular insulin, have increased 354% since 2007, even though the drug is not a new technology.

Rory Rickert with The Stephen Group, a consultant hired by the task force to help it recommend changes to Arkansas’ health care model, told legislators that the state should remove limits it has placed on prescriptions for certain drugs, such as insulin, which is a cost-effective way of treating diabetes. Rickert said the state should expand its preferred drug list.

Rickert encouraged legislators to create ways of reducing the abuse of pain-killing opiates. He said the United States has less than 5% of the world’s population but consumes 90% of all oral opiates, and the problem is worse in the South. One way to reduce opiate abuse is to lock users to one prescriber, but of the state’s 28,000 opiate utilizers, only 70 have been locked in, he said. Another issue: Medicaid personnel don’t have access to a statewide database of opiate users.

Legislators also heard from two companies, Express Scripts and CVS Health, about the possibility of them serving as a pharmacy benefit manager for the state that would manage a prescription drug program.