Missouri bill would help patients get just what the doctor ordered

Wednesday, March 17, 2010 | 12:01 a.m. CDT

JEFFERSON CITY — After Tracy Joyce fell in the state Capitol and had surgery on her shoulder, her surgeon extended her prescription to Celebrex for arthritis pain. But her insurance company disagreed and would initially only pay for a drug similar to Advil and Aleve.

Even though Joyce's history of ulcers made such medicine problematic, she took that rather than paying out of pocket for the prescription drug.

"I thought I was in the Bermuda Triangle," Joyce said. "This whole thing has just been a nightmare to me."

Joyce, a House legislative assistant, told the Senate Commerce Committee on Tuesday that she supports a bill to make it easier to override such insurance company restrictions.

The bill addresses the practice of treating a patient with alternatives to the prescribed or brand-name medicine. In such cases, insurance companies only cover the prescribed drug if the other drug is found to be ineffective.

The bill, sponsored by Sen. Kurt Schaefer, R-Columbia, would regulate the third-party groups that research whether alternative medicines are feasible.

It would require oversight when the groups recommend alternative medicine that's cheaper than the prescribed medicine. It would also require them to disclose financial incentives for requesting such a switch and explain the possible health effects the new medication may have.

Missouri law doesn't specifically address these groups.

At least three such groups currently operate in the state, said Jorgen Schlemeier, lobbying on behalf of Missouri Pharmacy Association.

Michael Harrold, an executive from one of the groups, Express Scripts, said regulation would slow down the process. He said it would increase paperwork and bureaucracy because it would require requests to swap medicines be sent to the state Department of Insurance.

He also said Express Scripts' business model makes drugs safer and more affordable.

No action was taken on the bill following the committee hearing. It could vote on the bill as early as the next meeting, which is scheduled for Thursday.

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