Introduction

Prescription drug coverage is essential for Medicaid beneficiaries. People with Alzheimer's disease often rely on prescription medications to help manage behavioral symptoms.

An important question for Medicaid beneficiaries with Alzheimer's disease is whether they will have access to the drugs they need. The mean monthly cost of prescription drugs for persons with Alzheimer's disease is $246.46, or nearly $3,000 annually.

States recognize that rising drug prices are placing essential drugs beyond the reach of most seniors and, though not required, include prescription drugs in their Medicaid benefits packages. However, rising Medicaid drug expenditures are also placing a burden on already strained state budgets; pharmaceutical costs are the fastest-rising component of state health care spending.

States employ various strategies to reduce these costs, including:

• Prior authorization for certain drugs

• Limits on drug claims and supply amounts

• Use of generics whenever available

• Co-payments

• Drug formularies

Our position on Medicaid prescription drug formulary

The Alzheimer's Association recognizes that drug formularies are a growing part of the health care system and that plan policies use formularies to balance health care needs and cost containment.

The Alzheimer's Association recommends that the following provisions be included as part of any drug formulary:

1. Disclosure of information to enrollees on:

   • The list of drugs included on the formulary.

   • The process by which a formulary is evaluated and updated.

   • How to receive coverage for a drug not included in the formulary.

   • How the off-label use of drugs is included in the formulary.

   • The process by which enrollees may access recently approved drugs that may provide better benefits than current treatments.

2. A mechanism that allows the physician to prescribe treatment not included in the formulary.

- Adopted by the Alzheimer's Association National Board of Directors, November 1997.

What we are doing

Alzheimer advocates throughout the country are working to ensure that the care needs of people with Alzheimer's disease are met in a timely and appropriate manner. Drug formularies, whether as part of the state's Medicaid program or a managed care plan, must provide access to safe and effective treatments for the disease.

Contact your local Alzheimer's Association to find out more.