Medi-Cal’s Medication Payments Reinstated

Medi-Cal recipients won back millions of dollars worth of prescription drug benefits Thursday when Los Angeles Superior Court Judge John L. Cole ordered immediate reinstatement of several cuts made by the state in a 1982 effort to save money.

“The judge’s order will cost the taxpayer about $47.1 million (a year),” Deputy Atty. Gen. John Spitler said. Although the federal government will pick up about half the tab, Spitler said, “it’s still going to cost the taxpayer.”

His position was disputed by an attorney for plaintiffs in one of the two lawsuits against the state Department of Health Services that resulted in Thursday’s order. Ronald S. Marks contended that if Medi-Cal patients get the medication they need, taxpayers will have to pay for fewer doctor visits and hospital treatments.

Despite the state’s attempt to win a delay, Cole signed two preliminary injunctions making available nine categories of prescription drugs that were eliminated in the 1982 law that was intended to save $394 million and hold down dramatically rising Medi-Cal costs.

‘Intends to Comply’

There are an estimated 2.7 million Medi-Cal recipients, most of whom are eligible for free drugs.

Spitler said the state “intends to comply, of course.” But he added that it also plans to seek a stay of the judge’s order from the U.S. Supreme Court.

Cole’s orders Thursday were directed by the state Court of Appeal, which last Dec. 21 found the state cutbacks to be in conflict with federal law, which forbids Medicaid agencies to arbitrarily discriminate on the basis of diagnosis, illness or type of condition.

The state petitioned the California Supreme Court for a review after the appellate court ruling in December but was turned down last Feb. 14.

The prescription drugs ordered restored Thursday include antihistamines, anti-malarials, analgesics, diuretics, sedative-hypnotics, dermatological preparations, ophthalmic decongestants and a category embracing expectorants, cough preparations and nasal decongestants.

They had been slashed from the Medi-Cal formulary by the Legislature on Sept. 1, 1982, to reduce program costs. After a rocky road through the courts, the cutbacks were implemented Jan. 1, 1983.

A month before the cutbacks were implemented, Los Angeles Superior Court Judge Leon Savitch, saying he “personally decried” the Legislature’s decision to cure its fiscal problems by slashing Medi-Cal services, dissolved a restraining order and an injunction he had issued in the two suits challenging the state’s action.

Medi-Cal patients still could obtain necessary prescription drugs through a treatment authorization program requiring doctors to obtain permission from Medi-Cal officials before prescribing them. Attorneys for benefit recipients argued that this prior authorization request format was cumbersome and inhibitive. One of the two companion cases was taken to the appellate court, which resulted in Thursday’s action.

‘Such a Hassle’

“We argued that the prior authorization request was so cumbersome, such a hassle, that (the drugs obtained through that route) were practically removed from the program anyway,” Marks said.

The state had asked Cole for a 70-day delay in issuing the injunctions, saying it would take that long to gear up to reimbursing pharmacists for the reinstated prescription drugs, but Cole denied the request, making the order effective immediately.

Philip R. Recht, an attorney for recipients in the other case, said the order has been broadened to apply to all eligible Medi-Cal recipients, not just those plaintiffs who challenged the state in court.

Although there may be some delay in the state’s getting the machinery in motion for reimbursement, he said it will be the pharmacists who have to wait, not the Medi-Cal recipients.