Fla. Medicaid, Drug Firm Reach Deal on Antipsychotic Drug

A battle between Florida’s Medicaid program and a major drug manufacturer was resolved this week, meaning the 16,000 Medicaid recipients in the state who take the antipsychotic drug Zyprexa won’t have to jump through a series of administrative hoops to remain on the drug.

While moving the state’s Medicaid population to a “preferred drug list” in July in order to rein in Florida’s rising medical costs, health officials blasted Eli Lilly as the only company unwilling to lower prices to qualify its drugs for the state list.

Lilly fired back, saying Florida officials were unwilling to listen to any alternatives to simply lowering prices.

The stalemate resulted in the Agency for Health Care Administration, which runs Medicaid in Florida, removing Zyprexa from its drug list.

That left the thousands using Zyprexa to either find a new drug to battle their schizophrenia and bipolar disorders, or have their doctors go through a process to clinically prove to state officials that it is the only drug that works for their patients. Mental health professionals worried that such a process would be too lengthy and lead to a potentially dangerous interruption in the medication of these delicate patients.

But on Monday, AHCA announced that Lilly had finally agreed to lower its prices and the drug was back on the list.

“Continuity of care in the administration of prescription drugs is an important component to effective disease management,” said AHCA Secretary Alan Levine. “We remain committed to work with Eli Lilly and other drug manufacturers to ensure participants receive their appropriate therapies.”

Lilly spokeswoman Carole Puls said they agreed to lower the prices in exchange for a continuity-of-care agreement, where the amount of patients that remain on Zyprexa helps determine the drug price.

In other words, Puls said the more people who stay on Zyprexa, the lower the company will sell the drug to the state.

“We are not trying to tell doctors that they have to keep their patients on a certain drug,” Puls said. “It just leaves the door open for that.”

Other drugs added to the preferred list in Monday’s announcement were Depakote ER, Keppra, Lamictal, Trileptal and Zonegran, a variety of mental health drugs.

– alan_gomez@pbpost.com