Like thousands of Kansans, Shirley Russell’s pharmacy bill is one of her biggest expenses.

Sixty-seven-year-old Russell, Lawrence, spends up to $400 a month on prescription medicine for heart problems, diabetes, lung disease and other ills. And she said the cost would be twice as much if her doctor didn’t provide free drug samples.

Shirley Russel's monthly prEscription bill could easily reach 00 if she did not receive free drug samples from her doctor. She currently takes about 20 prescription medications.

“It’s hard to stretch your money that far when you don’t have the opportunity to make money,” said Russell, who uses about 20 different medications.

Russell’s situation mirrors that of Kansas’ Medicaid program, a state and federally funded system that provides health care to the poor. Prescription drug costs for Medicaid are the largest expense in the program, reaching nearly $200 million per year. That’s about double what prescription drug costs were five years ago.

But what if those costs could be significantly reduced for Russell, who is not on Medicaid, and for taxpayers who are bankrolling Medicaid?

That’s what some lawmakers are hoping to do this year as they search for ways to fill an estimated $500 million revenue shortfall in a $4.5 billion budget.

“If people are interested in saving money, they need to start asking the right questions,” said Rep. Dale Swenson, R-Wichita, who has introduced legislation to rein in drug costs.

Dollars and lives

Trying to reduce soaring pharmaceutical costs has gained momentum nationwide as many states deal with budget deficits and many drug makers record huge profits, according to the Center for Policy Alternatives, a Washington, D.C.-based group that pushes for health reforms.

And more is at stake than money.

The increasing costs of prescription drugs, which are rising at twice the rate of inflation, are putting people at risk by forcing them to skip doses or do without, said Jesse Romero, who is with the Center for Policy Alternatives.

And policymakers across the country, as in Kansas, are considering ways to limit programs to help trim costs.

Romero was in Topeka last week to talk with legislators about the problem.

Swenson’s bill is patterned after similar legislation that the policy group has supported in Florida and Maine.

“These programs are up and running and demonstrating savings,” Romero said.

The legislation is designed to spur drug makers to offer large discounts and rebates or risk being put on a list where doctors would have to receive prior authorization from the state before being allowed to prescribe that brand of medicine.

Swenson’s measure would also establish a program to allow uninsured Kansans earning up to three times the federal poverty level access to inexpensive drugs. The program would be funded through the savings in rebates and discounts from the drug makers.

Drug manufacturers have fought this initiative in court in other states. The proposals limit people’s choices in medicine, according to the Pharmaceutical Research and Manufacturers of America, the nation’s largest trade group of brand name drug makers.

Explaining the Florida law, Jan Faiks, assistant general counsel for the group, said if manufacturers refused to pay a supplemental rebate for a drug, the drug is put on a prior authorization list “even if the drug was a better or safer drug.”

So far, the legal rulings have been split. The laws have been upheld in Florida and Maine, but shot down by courts in Vermont and Michigan, though the cases continue on appeal.

Bob Day, director of medical policy and Medicaid for Kansas, said Swenson’s proposal was an “intriguing possibility” but said more study was needed to see if it would work in Kansas.

Day said there are significant policy questions that must be answered.

“What drugs do you not want people to get? You have got be careful you are not throwing the baby out with the bathwater,” he said.

Though prescription drugs have become the No. 1 expense in Medicaid, he said, the medicines are keeping many people out of more expensive hospital care.

Day conceded drug costs were getting out of hand and that the state needs to take action. The pharmaceutical companies, he said, are “smarter than anyone I know.”

Through aggressive television marketing, drug makers have created demand for their products.

Day summarized Swenson’s bill as “a legal way of extorting money from people who are ripping us off.”

But Swenson said it was merely a way of getting the “drug companies to the table to negotiate.”