OLYMPIA, Wash. – DSHS medical assistance clients with new prescriptions in three drug classes on the state's Preferred Drug List will be expected to try less-expensive generic medications first under a cost-saving initiative that begins November 1.

The Generics First Initiative will not change brand name prescriptions for patients already taking those medications, according to Doug Porter, DSHS assistant secretary and State Medicaid Director.

"This affects only new starts – people who have not been on either brand-name drugs or generics in that particular drug class," Porter said. "The generic and brand-name drugs are equally effective, but we will not block prescriptions for the brand-name drugs when the prescriber can define a medical reason for using that medication."

The three drug classes that will be affected immediately are:

• Antipsychotic medications in children
• Attention Deficit Hyperactivity Disorder (ADHD) medications for children and adults
• Proton Pump Inhibitors (PPI) used to treat heartburn

Generics First
Generic drugs are the full equivalent of brand-name medications, but often are priced far below the brand-name price. Clients concerned about receiving a prescription for a generic drug should talk to their provider or the pharmacist dispensing the medication.

Dr. Jeffery Thompson, Medicaid's chief medical officer, said the state Pharmacy and Therapeutics Committee/Drug Utilization Review Board, which oversees and advises the state's Preferred Drug List, has also authorized the agency to add adult antipsychotic medicine to the list sometime in the future.

The first three classes of drugs all rank in the top five most-expensive drug categories for the state's Medicaid program. The adult antipsychotics are the No. 1 expensive drug on the state's list, accounting for more than $100 million in prescription costs a year.

Dr. Thompson said the generics initiative is an attempt to boost the state's generic fill rate from its current rate of 63 percent.

"Each single percentage point increase in the state's generic use represents about a $4 million savings in medical reimbursements," he said.                                                                       

The initiative was part of $200 million in smart-purchasing strategies designed by the Medicaid program earlier this year and incorporated in the current budget. The initiative needed to be approved by the Drug Utilization Review (DUR) Board, however, before it could take effect.

The initiative also has a quality-improvement dimension, coinciding with other state efforts to make sure that doctors are not overprescribing antipsychotic or ADHD drugs for children.

"We are the first state to provide dosing guidelines for those drugs and to institute a system to make sure prescribers seek a second opinion when they want to deviate from those guidelines," said MaryAnne Lindeblad, director of the Division of Healthcare Services in DSHS. 

Lindeblad said the generics move also involved consulting with physician and pharmacist groups across the state, making sure that the medical community was behind the changes and understood their significance.

She said the Medicaid program also has begun printing a generics newsletter for prescribers, showing current rates of use and illustrating the savings that may be possible by altering prescribing behaviors.

"If you saw a miracle pill advertised on television in the past, you could go into your doctor the next day and ask for it – and often get it," Lindeblad said. "Under the initiative, we are providing some incentive for the doctor to explain that the generic drug in that class is just as effective and wonderful – it just doesn't have a big television advertising budget."

Dr. Thompson said providers with questions about the initiative are welcome to contact him. They also can request a copy of the generics newsletter by e-mailing stevejh2@dshs.wa.gov

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FOR ADDITIONAL BACKGROUND, CONTACT:
Jim Stevenson, Communications Director, HRSA, DSHS, 360-725-1915 (Pager: 360-971-4067).