Pharmacy costs are the highest and most rapidly increasing costs for the Medicaid Program. From 1999-2004, pharmacy costs have increased from $5.5 million to $1.4 billion.
Since 2003, Medicaid has covered Over-the-Counter (OTC) Proton Pump Inhibitors and Non Sedating Antihistamines. If 50% of prescriptions in these 2 classes were for an OTC formulation, we could save Medicaid more than $50 million. This cost savings could then be put towards services that could benefit patients and providers.
In response to this, the Medical Policy Committee for Community Care of Wake and Johnston Counties have developed Standing Orders allowing for a formulary interchange at the pharmacy to an OTC medicine for these 2 classes of medicines.
If you would like comparative data on medicines in these classes, a good resource is the Drug Effectiveness Review Project housed at the Oregon Health & Science University. Their website is
http://www.ohsu.edu/drugeffectiveness. From the home page, you can click on Documents, then Final Documents, then Antihistamines, Newer or Proton Pump Inhibitors.
Tools:
Pharmacy Prior Authorization Program for Proton Pump Inhibitors
Standing Orders Provider List
Standing Orders Practice List
Pharmacy Interchange Form
Standing Orders PPI
Standing Orders NSA
DMA Policy for OTC Coverage
