State: Lawmakers say prescriptions cheaper by mail

TALLAHASSEE -- To curb rising prescription drug prices, the Legislature wants to steer Medicaid patients away from the local pharmacy and toward what lawmakers see as a cheaper, more convenient alternative: mail-order medicine.

The state hopes to save $1.5-million next year without compromising care, but retailers and pharmacists who stand to lose customers oppose the idea and some lawmakers are skeptical about whether it will work.

Florida entered the mail-order market when Health Alliance, an Illinois company represented by two prominent health care lobbyists, outbid three other firms and was given a three-year, $40-million contract last July. The company agrees to sell insulin and other materials at lower prices to about 7,000 Medicaid patients living in a 30-county area stretching from Tampa to Jacksonville, including all of Pinellas and Hillsborough counties.

Those patients must buy all diabetic medicines from Health Alliance, but they have a choice of whether to buy all other prescriptions from the company.

Last week, the Legislature expanded the company's reach by allowing that same pool of patients to buy all their prescription drugs by mail.

"The primary reason for doing it, although we will save some money, is if individuals get certain products by mail, they may want to get others. It's voluntary," says Bob Sharpe, the state's director of Medicaid. "What we're trying to accomplish is convenience and at cheaper prices."

The mail-order test market of 7,000 diabetics is a tiny fraction of Florida's 1.8-million Medicaid subscribers, and the mail is already an option under many private health plans. But the retail and pharmacy lobbies doubt it will work for Medicaid patients.

Michael Jackson, a lobbyist for the Florida Pharmacy Association, says obtaining drugs by mail will be a "nightmare" for Medicaid patients as they learn a new way of getting their life-sustaining drugs. He also cited the case of an independent pharmacy in Live Oak where nearly half of all prescriptions are for Medicaid recipients.

"Money? It is part of our concern," adds John Rogers of the Florida Retail Federation, which lobbied against a mail-order expansion. "But the bigger concern is whether Medicaid patients are being properly served."

Health Alliance vice president John Tollefson said his company must provide drugs at 20 percent below the average wholesale price and some medical items free of charge, such as lancets and alcohol cleansing wipes.

The company mainly uses United Parcel Service to deliver drugs, pays all shipping costs and has a 24-hour toll-free phone number to field patients' questions.

"Our anecdotal evidence has been very positive," Tollefson said.

The voluntary expansion of mail-order medicine was in a Senate amendment to a bill that adjusts the budget of the Agency for Health Care Administration that passed in last week's special session. When the bill came up for debate, the only controversy concerned the mail-order medicine provision.

The sponsor of the expansion provision was Sen. Ron Silver, D-North Miami Beach, the chairman of the appropriations subcommittee for human services. Silver said he had been lobbied to support expansion by Health Alliance's lobbyists but that the idea was the agency's.

Those lobbyists are Greg Coler, an ex-secretary of the state human services agency in a previous Republican administration, and Doug Cook, who ran AHCA for Democratic Gov. Lawton Chiles. Coler did not respond to phone messages left at his office on two days, and Cook declined to be interviewed.

Sen. Al Lawson, D-Tallahassee, said the program will have a "detrimental effect" on some independent drug stores in small towns that have come to rely on Medicaid as a vital source of income.

As senators gathered around Silver or peppered him with questions, his frustration and his voice, rose. Silver concluded -- wrongly, some colleagues said -- that the questions had been orchestrated by pharmacy industry lobbyists. Silver was angry because lawmakers had agreed to spare druggists a reduction in dispensing fees.

"Let me tell you, I have no sympathy whatsoever for the poor pharmacists," Silver shouted across the chamber. "They have to share in this also. We had to cut, cut, cut, cut."

Sen. Jack Latvala, R-Palm Harbor, complained that his constituents were being used as "guinea pigs" in pilot health care projects.

"In this time of economic uncertainty, perhaps we wanted to go a little slower in reducing business to people who live and work in our districts every day, and giving that business to a mail-order company out of the state of Florida," Latvala said.

The final vote on the bill was 22-13, the closest vote on a major bill during the two-week special session. A dozen Democrats and Latvala voted no.

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Lucy Morgan

From the Times state desk