|
Monday, October 18, 2004
Doctor targets limits on prescriptions
Copyright © 2004 Blethen Maine Newspapers Inc. | ||||
 |
||||
Dr. Richard J. Dubocq, an board-certified physician in family practice and geriatrics, says state rules limiting the drugs under MaineCare, interferes with doctors' ability to prescribe the right drugs for their patients. Dubocq says that can harm patients and end up costing more for additional hospitalizations or other care. Doctors have seen more and more prescription drugs being taken off the shelf of medications available for poor patients, particularly for those in nursing home, she said. The new restriction limits the number of brand-name prescription drugs allotted to each nursing home patient to five even if that same person was receiving more while living on their own. "The time has come for those of us concerned about quality healthcare to publicly express our concerns regarding MaineCare's ever-increasing interference with doctors' ability to prescribe the medications they feel are best for their patients," Dubocq wrote in an open letter to doctors and the public. The Albion physician said more attention by doctors and the public needs to be focused on the state's advisory Drug Utilization Review Committee which recommends drugs to be on the preferred list for MaineCare patients. In theory, Dubocq said, additional prescriptions can be provided if the doctor submits "prior authorization" forms. But physicians are reluctant to apply if they think the effort will be unsuccessful. "You get the feeling it's a slowly tightening noose," Dubocq said. Final policy decisions are made by officials of the state Bureau of Medical Services, said Department of Health and Human Services spokesman Newell Augur. State officials had to take action in 2000 after state Medicaid drug costs rose by 20 percent in the four previous years. "We are trying to steer MaineCare clients to more clinically appropriate and cost-effective drugs," the department spokesman said. Augur said more than 80 percent of requests for prior authorizations are approved. "We've made a lot of progress in streamlining this and we've made a number of changes to drugs" on the approved list. Andrew B. MacLean, general counsel of the Maine Medical Association, said Dubocq is not alone in his concerns. "The most complaints come from the docs who deal with sensitive populations, the geriatricians dealing with the elderly and long-term care, the pediatricians, psychiatrists and the physicians dealing with chronic pain medication," he said. The restrictions began in 2000 to save state money when budgets were tight. "They have taken input from us. But they've made it very clear they're not going to react favorably to criticism of the system that the whole process stinks," MacLean said. Because the restrictions are imposed on physicians by a little-known state agency the potentially politically-charged cuts show up in doctors offices rather than the State House. "It's rationing, just below the surface," MacLean said. "And hold onto your hats because they have to be preparing a worst-case budget somewhere" to cut more medical services to respond to expected new budget cuts, he said. "There aren't going to be any easy answers." Dubocq is encouraging other doctors to become more involved. Gary Remal -- 623-3811, Ext. 518 gremal@centralmaine.com |
||||