Tuesday, December 10, 2013
By ANN WOLOSON
HALLOWELL - It was refreshing, if not a relief, to witness the Legislature's Government Oversight Committee's hearing on a recent report about how Maine's Department of Corrections provides health care services to prisoners.
Committee members appeared genuinely concerned about inadequacies described in the report from the Office of Program Evaluation and Government Accountability. Problems ranging from patients not receiving standard medical services to a lack of timely responses to sick calls, questions about whether patients receive medications as prescribed, lack of documentation and other contractual deficiencies were well-documented in the report.
Thoughtful questions were asked of inmate advocates who described their experience with and knowledge of the system. Suggestions on how the state could provide more timely and more humane care were requested. Contractors were asked about their lack of adherence to contracts and why they thought the state should use them again. The committee seems to be doing what it should in terms of using the report to improve government services.
I hope the Corrections Department will do the same and use recommendations in the report to improve the way health care resources are provided, which will help to contain overall prison health care costs. It calls on the department to "continue to pursue cost containment strategies through new health care services contracts."
Containing costs is important for obvious reasons. However, shortsighted measures can end up costing the system more in the long term.
Corrections Commissioner Joe Ponte said he's taken steps to lower costs, including reducing the number of medications issued to patients from an average of seven previously to five, and fewer down the road.
Sparing prisoners from unnecessary prescribing is a worthy goal. Comparing the number of prescriptions written in Maine to other states and reducing that figure to conform, however, will not help improve care quality. Such a measure could actually increase costs.
The commissioner would be better off taking a closer look at the medications it provides and assessing whether Maine is getting the best value for what it spends on drugs.
A study published by American Health & Drug Benefits in September/October 2010 compared drug formularies for eight major health plans in Minnesota.
It found that significant savings could be attained if plans made better use of "evidence-based, recommended" prescription drugs, which are proven to be the safest, most clinically effective and cost-effective options. In most cases, generics are the top choice in terms of quality and cost.
I'm not saying that prisoners receive inferior medicine. Evidence-based choices are what I want for myself and my family when we are sick. While we all want the best treatment available, we often mistakenly believe that more expensive drugs are more effective. Ultimately, most of us want the best drug available at the best price. Public (and private) payers should want the same.
Consumer Reports Health's Best Buy Drugs guide offers free, unbiased reviews of prescription drugs, including their effectiveness, safety and cost. When buying a new car or computer, many of us would seek similar data on products we are considering. Why wouldn't we do the same research on drugs we are prescribed?
The Corrections Department should work with its prescription drug contractor to make sure the products it provides are proven to work best, are safe and cost-effective. Reports of prescription benefit managers steering consumers toward more expensive drugs have appeared recently, especially as the patents end on top-selling drugs like Lipitor.
Prescription benefit managers are instructing pharmacies to fill prescriptions with the brand-name drug, rather than the less expensive generic equivalent, which means health plans will miss out on savings.
There are other examples of the promotion of more expensive products over safer, more effective options. Avandia, the most profitable brand-name oral diabetes drug in the U.S. over the last decade, was recently pulled off the market because it was associated with increased heart attack risk. Private and public plans were paying top dollar for this drug although the evidence showed a generic to be just as effective, safer and more cost-effective.
The Corrections Department shouldn't just limit access to services as a means to reduce costs. Instead, it should work to ensure its contractors are optimizing the use of limited health care resources. Providing evidence-based prescription drugs to our prisoners will improve health care status and result in cost savings.
Ann Woloson is executive director of Prescription Policy Choices, a Hallowell nonprofit whose goal is to improve access to effective, safe and affordable prescription drugs.