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    Bill would mandate 4 generic drugs

    By TIM NICKENS

    © St. Petersburg Times, published May 3, 2001


    TALLAHASSEE -- In what would mean a savings for thousands of Floridians, pharmacists could substitute less expensive generics for four brand-name drugs under a bill sent to the governor Wednesday.

    The list of affected drugs includes the popular brand-name blood thinner Coumadin. If the bill becomes law, pharmacists automatically would substitute the generic warfarin for Coumadin, unless doctors write "medically necessary" on a prescription for Coumadin.

    The bill was approved by the Senate on a 30-9 vote. Gov. Jeb Bush has not taken a position on the issue, a spokeswoman said.

    Pharmacists already are required by Florida law to fill prescriptions for nearly all brand-name drugs with generic equivalents. They must use the brand-name drugs only if doctors write "medically necessary" on the prescription.

    But Coumadin was among a handful of brand-name drugs on the state's "negative formulary" list. Any brand name on that list could not be substituted.

    Under the bill, Coumadin and three other drugs would be removed from the list and treated just like any other name brand drugs. Doctors who wanted their patients to receive Coumadin still could write "medically necessary" on the prescriptions.

    "Two words can be placed on the prescription pad that make it crystal clear if the doctor does not want a substitution," said Sen. Ron Klein, D-Delray Beach.

    The other three drugs involved are digoxin, a heart medicine; quininidine gluconate, also prescribed for heart ailments; and phenytoin, prescribed for epilepsy.

    For the past two years, then-House Speaker John Thrasher blocked the proposal. The legislation was opposed by the Florida Medical Association, and Thrasher was the FMA's former general counsel.

    The battle this year featured high-powered lobbyists on both sides. DuPont, which manufactures Coumadin, tried to protect its product as Barr Laboratories argued for its generic equivalent.

    "This is not about anything but two companies knocking heads over market share," said Sen. Jim Horne, R-Orange Park, this week as he tried to fight the bill. "I think the relationship between doctor and patient is almost sacred."

    But the Senate rejected Horne's attempt this week to change prescriptions so that doctors would be forced on all drugs to sign their name beside either "medically necessary" or "substitution allowed."

    The company and supporters of the bill argue that warfarin is the exact same as Coumadin and that people who take Coumadin could save about $12 if they are allowed to buy warfarin instead.

    Supporters of the bill said it will benefit Floridians and does not pose a health risk. Sen. Charlie Clary, R-Destin, said the change is expected to save the state $4-million in Medicaid costs each year. He said people who pay for prescriptions themselves or with private insurance would save about $15-million.

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