Texas recently excluded Zyprexa, a second-generation antipsychotic sold by Eli Lilly and Co., from its Medicaid preferred drug list (PDL).
Texas physicians are now required to receive prior authorization before prescribing drugs that are not on the PDL.
According to the March 1 Wall Street Journal, a committee of pharmacists and physicians advised the state’s Medicaid program to include the antipsychotics Risperdal (risperdal), Abilify (aripiprazole), Seroquel (quetiapine), and Geodon (ziprasidone) on the list.
Reporter Leila Abboud wrote that Zyprexa is the most expensive atypical antipsychotic on the market and that in 2003 the drug accounted for $86 million of Texas’s expenditure of $187 million on second-generation antipsychotics.
Kentucky and West Virginia previously removed Zyprexa from their PDLs.
The actions in those states signify a change, because antipsychotic medications in most states have been exempt from requirements for prior authorization.
With increased strains on Medicaid budgets, however, state officials are taking a serious look at ways to reduce or stabilize the cost of antipsychotic medications (see pages 19 and 20).
Those sales are important to pharmaceutical companies.
Richard Frank, Ph.D., a professor in the department of health care policy at Harvard Medical School, told Psychiatric News, "In 2001, Medicaid programs bought 70 percent of all antipsychotic medications purchased in the United States."
An article in the February 1 New York Times described how state government officials have become the target of various "marketing tactics" by pharmaceutical companies because of the financial importance of sales of antipsychotic medication to Medicaid programs.
Psychiatric News will report developments regarding changes in access to antipsychotic medications through Medicaid. Please send information on this topic by e-mail to firstname.lastname@example.org with a copy to Karen Sanders of the APA Office of Healthcare Systems and Financing at email@example.com. ▪
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