Sharron Lobaugh says her son tried 18 drugs over 15 years - and spent about three years in the hospital - before he found a medicine that successfully controlled his schizophrenia.
Now she worries that a state effort to lower prescription drug costs could hamper recovery for her son and others with serious mental illnesses by limiting the types of medicines the state will pay for.
"These are people who are extremely needy and their medication is one of the most important steps in their rehabilitation," Lobaugh said.
State health officials say the preferred drug list they're developing will let doctors prescribe the most effective drugs for Medicaid patients and will help control costs so the state doesn't have to cut other services for needy Alaskans.
But development of the list has drawn criticism from some doctors and drug manufacturers, who say the state is moving too quickly and without consulting enough experts.
The state decided last year to follow the lead of 17 others states that have developed a preferred drug list.
The idea is to discourage doctors from prescribing expensive medicines that don't work any better than cheaper drugs, said Dwayne Peeples, who heads the state Division of Health Care Services.
Medicaid will pay for a drug that doesn't make the list only if the doctor specifies that it's necessary and gives a reason that falls within the state's guidelines, such as an allergic reaction to the approved drug.
The drug list is one of several steps the state is taking to control its spiraling budget for Medicaid - the state and federally funded program that pays for some low-income Alaskans' medical care.
Alaska's Medicaid program cost more than $750 million in the 2003 fiscal year, with prescription costs making up almost $100 million of that, said Health and Social Services Commissioner Joel Gilbertson.
"The reason we're doing this is because this amount of money does have consequences," Gilbertson said.
The Medicaid program expects to save $20 million in the coming fiscal year by using the list. That would buy medical care for almost 10,000 children in the state Denali KidCare program, Gilbertson said at a recent legislative hearing on development of the list.
Which drugs go on the list is being decided by a 24-member committee that includes pharmacists and doctors from specialties ranging from anesthesiology to geriatrics to dentistry to psychiatry. The state hopes to finish the list by the end of 2004.
Drug manufacturers argue they haven't been given enough notice to prepare for meetings and they haven't been given enough time to speak at the meetings. And they say the panel doesn't include enough experts in some medical specialties.
Gilbertson said the department has exceeded state public notice requirements and has given the pharmacy companies as much, or more time, to speak at meetings as many other states have.
Not every medical specialty is represented on the decision-making committee, he said, information from specialists is sought before meetings and presented to the panel members.
Dr. Alex Malter, president of the Alaska State Medical Association, said the pharmacy industry may have some legitimate gripes.
He said he supports what the state's trying to do but worries it's moving too fast and relying too much on its contractor, First Health Services Corp., for advice on what drugs to approve.
"I think it is a bit disingenuous to argue you could go through four classes of drugs in an afternoon," Malter said. "It is important that these classes are carefully considered and not just rubber-stamped."
He fears if doctors have too much trouble getting approval for drugs that aren't on the list, some will simply quit treating Medicaid patients.
Dr. Verner Stillner, a representative of the Alaska Psychiatric Association, wants the state to leave psychiatric drugs out of the process altogether.
"I'm going to argue vehemently for those to be carved out because I think the brain is different from the other organs of the body," Stillner said.
Response to those drugs varies widely and can be affected by gender, age and race, Stillner said. It can take up to six weeks to know whether a drug is working, and many have side effects that are hard to manage and may discourage patients from continuing the medication.
Not everyone is unhappy with the state's efforts.
The senior citizens organization AARP supports the plan. Pat Luby, advocacy director for AARP in Alaska, said the group views it not only as a cost-saver for the state, but also as a sort of "consumer reports" on the best value in prescription drugs for all Alaskans.
For more information, go to:http://hss.state.ak.us/dhcs/PDL/default.htm