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Monday, August 01, 2005

PDL Decision

By John L. Valentine
President, Utah State Senate

Last week the Utah Legislature’s Executive Appropriations Committee declined to institute a Preferred Drug List (PDL) policy that would require Medicaid recipients to use drugs on a discount list or go through a prior authorization process. A few reporters and editors were quick to broadcast their assumption that this decision was driven by political contributions. That assumption is wrong.

In 2001 the State of Maine implemented a PDL policy - one of the first in the nation. Six months ago they issued a report which scrutinized their system and found what they characterized as “disturbing trends.” According to the report

* Emergency room visits have increased;

* Hospital admissions and patient referrals to specialists have increased;

* Many patients experience a worsening of their medical condition as they jump through the hoops to get medications not on the PDL;

* Many patients are forced to go to the doctor multiple times to get the right medicine;

* Medical staff time and attention is diverted from patient care to handle “voluminous paperwork” and increased calls from patients;

* Doctors are cutting off or limiting the number of Medicaid patients they accept due to the increased administrative burden; and

* Quality of care has decreased and patients have suffered painful consequences.

They reported, “while [a PDL] is an important cost containment tool, aspects of its implementation have adverse consequences directly affecting the health care of thousands….” Other PDL states are also experiencing serious problems.

I found these concerns to be compelling.

As a taxpayer and legislator, I would like nothing more than to save money in our Medicaid program. The bottom line for me, however, is that I am unwilling to conduct medical experiments on our most vulnerable citizens.

Some have asked why we don’t just approve a limited program to see how it would work. The answer is simple. We imagine that we might well save a significant amount of money in the short term, as have Maine and the other PDL states. Short-term savings, however, are only part of the equation.

Let’s look at the dynamics that would be set in motion. A limited program is likely to generate quick positive numbers while the long term impact and human cost would remain unquantifiable for several years. Stories of frustration and tragedy would have a difficult time competing with clear financial data which would build political momentum in favor of PDL’s, to the injury of a population that is already striving to overcome immense challenges.

In other words, this train has no breaks. I do not want it to start rolling down the mountain when we know there are people on the tracks below.

Maine is currently investigating the administrative problems caused by their PDL program. At some point in the future they plan to try to quantify the human damage caused by the program to determine if the money they saved was worth the cost.

At this point, I am unwilling to plunge Utah into a similar experiment. Perhaps we can revisit the issue when the bugs are worked out of the PDL system.

Seven legislators on Utah's Executive Appropriations Committee voted for a Utah PDL; nine voted against it. Each was lobbied fiercely from all sides of the issue. Each has their own reasons for the judgment call they had to make. They are all good legislators. They did their job. You will find your representatives to be far more informed, far more sincere, and more compassionate than the two dimensional caricatures portrayed by recent media accounts.


John L. Valentine
President, Utah State Senate

[This letter was published in Sunday's Daily Herald. A shorter version was published in the Salt Lake Tribune.]


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