Senate advances Medicaid preferred-drug changes aimed at saving on pharmaceuticals

The Utah Senate on Feb. 25 approved first substitute Senate Bill 137, which expands the state Medicaid Preferred Drug List (PDL) to include additional medications, with sponsor statements indicating projected savings and safeguards for patients.

A presenter noted that Medicaid spends roughly $150–175 million a year on drugs for program clients and that the PDL mechanism has produced greater savings than initially estimated. "A number of years ago ... the Medicaid program spent $175,000,000 a year on drugs for the Medicaid clients," the presenter said, arguing the PDL offers negotiating leverage to lower drug costs.

The bill keeps intact an override process so that patients stabilized on a medication can remain on that drug with an approved bypass. Supporters, including the Utah Medical Association, the Association of Family Physicians, pediatricians, AARP and pharmacists, urged passage. The bill also directs some of the savings to mental-health providers ($615,000 in the near term) and an ongoing appropriation for emergency dental services ($200,000).

Opponents raised concerns that prior assurances that certain mental-health medications would be protected should not be reversed. Senator Davis warned that mental-health patients often have chronic conditions requiring multiple prescriptions and said limiting access or changing drugs without careful oversight could increase emergency-room visits and other costs.

Senators debated the balance between cost control and patient needs; sponsors stressed federal Medicaid rules prohibit excluding drugs and said the PDL is not a formulary that denies access. After debate and a call of the Senate, SB137 passed on roll call (reported 16 yea, 10 nay, 3 absent).