US Drug Firms In Fight Against Formularies

Drug companies and civil rights groups are allying against state efforts to control costs of prescription drugs paid for by US state Medicaid programs through the use of formularies. The civil rights groups say they aim to get Medicaid recipients access to the same quality of prescription drugs that the more affluent have. Drug firms take the same line but others feel they are more interested in profits, and some civil rights advocates such as the National Association for the Advancement of Colored People in Washington fear they are being manipulated by the companies in the debate.

Pfizer has been very active in the fight against formularies, especially in California, Alabama, Florida, maryland and Tennessee, where it has worked with advocacy groups such as black doctors' associations and black legislators. Pfizer underwrote the $67,000 cost of a conference criticizing Tennessee's newly revamped Medicaid program and discussing how recent cost-cutting measures could shortchange the poor. A doctor can prescribe a drug not on the formulary by getting permission from one of the pharmacy benefit managers hired to run the state's prescription drug program, say TennCare (the state medicaid program) officials, but doctors say this means time and more paperwork. The officials also say there are adequate substitutes for the drugs Pfizer wants added to the formularies and that these drugs are offered from companies that are willing to sell them at a discount.

Drugmakers looking at using federal civil rights statutes to overturn some Medicaid changes include Pfizer, says the New York Times; a lawyer there has set out a strategy using Title VI of the 1964 Civil Rights Act, which bars discrimination in any program receiving federal funds, as a way of overturning Tennessee's restrictive formulary. Black people make up 39.4% of the state Medicaid population, he said, and a challenge by a number of doctors to the state prescription drug policy could lead to a successful civil rights suit. Furnishing proof of problems of access to needed drugs could lose Tennessee federal government permission to continue its Medicaid reforms and face either radical Medicaid cutbacks or tax rises.