Senator proposes AHCCCS changes - East Valley Tribune: News

Senator proposes AHCCCS changes

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Posted: Friday, November 25, 2005 11:00 am | Updated: 10:04 am, Fri Oct 7, 2011.

Sen. Jack Harper doesn’t think Arizona taxpayers should be helping poor men with their poor sex lives. The Surprise Republican has introduced legislation to ban the Arizona Health Care Cost Containment System from providing coverage for any drug used to treat erectile dysfunction.

"I just don’t think it’s a necessary cost for the taxpayers,’’ Harper said.

He said the program should treat only "medically necessary’’ conditions.

"I just think the long-term health and welfare of the person on AHCCCS is not dependent on drugs to treat erectile dysfunction,’’ he said.

But the measure may do little to help the state’s budget.

Tom Betlach, deputy director of the state agency, said the change wouldn’t save any money immediately. In fact, Betlach said he doubts it ever would make any real difference to taxpayers.

AHCCCS is the state’s Medicaid program.

Anyone earning less than the federal poverty level is entitled to state-paid health insurance.

More than a million people are enrolled in the program.

The measure, SB1003, parallels a new federal law to take any erectile dysfunction drugs such as Viagra, Cialis and Levitra out of the new Medicare prescription drug program. It also ends reimbursement to state Medicaid programs for the same drugs.

Rep. Nathan Deal, R-Ga., sponsor of the federal legislation, said the government could save $690 million over five years by ending both subsidies, much of which the measure would funnel into hurricane relief.

But AHCCCS is set up different than most other state Medicaid programs where the government reimburses doctors, pharmacists and hospitals on a fee-for-service basis.

Here the state contracts with insurance companies and private plans, paying them a flat monthly fee to take care of all routine health care for each person enrolled.

Betlach said the average cost to the state is $250 a month per person. That figure is the same whether the provider prescribes many drugs a month — or none at all.

More to the point, Betlach said there is no mandate on providers to pay for erectile dysfunction drugs. He said it is up to each plan whether to allow its doctors to prescribe them.

Harper, however, said there has to be some cost built in by the providers for Viagra and the other drugs when they bid for the state contracts.

Betlach acknowledged the new federal law will forbid Arizona providers from using any of their government funds for these drugs. And that, he said, could theoretically force down future bids.

"But I doubt it even moves it a penny,’’ Betlach added, given the number of aging men in the $6 billion AHCCCS program who would be eligible for Viagra.

AHCCCS has no immediately available statistics for how many prescriptions for erectile dysfunction drugs are written by providers.

But there are about 19,300 men in the program 65 and older; overall, there are nearly 52,000 men age 50 and older enrolled.

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