States Sued For Pushing Cheaper Drugs Via Medicaid . Just when I think about taking it easy on the pharmaceutical industry - there they go again.

The most popular strategy is requiring prior authorization for high-priced medicines. More than a dozen states are developing preferred drug lists, and several demand extra rebates from companies that do not match the lowest price. Michigan's new program saves $800,000 each week -- or $42 million this year, according to Republican Gov. John Engler.

Oregon expects to save $17 million in the first two years, which would result in nearly $40 million in savings for the federal government, said John Santa, administrator of the state health policy office. Massachusetts and Vermont say they could save $10 million.

If the industry suits are successful, "it will throw the country into chaos," Rivers said. "There are too many big states whose budgets would be devastated by it."

Drug manufacturers argue that prescription medication saves lives and money by preventing emergency room visits and more expensive procedures such as surgery.

"The most economic service [states] can provide is adequate access to prescriptions because it gives the most bang for your buck," Faiks said.

"The Medicaid Act does not let them use prior authorization to hold patients hostage because of money," she said. Although PhRMA objects to the state tactics, the industry is suing the federal government in U.S. District Court in the District of Columbia on the grounds it does not have the authority to permit the state programs. In the lawsuits the industry is challenging the state programs, arguing that the government is more concerned with cost than the health of low-income residents.

PhRMA's legal brief contends that "physicians generally respond to the inconvenience and burden imposed by prior authorization requirements by switching their patients" to a drug on the preferred list. Over time, the suit notes, the shift in prescribing patterns results in large swings in the overall market.

If I understand the pharmaceutical industry, I should use the most expensive drugs to save the most money. Sometimes a very expensive drug makes a difference, but often we can treat the same condition with a less expensive alternative. Working with the indigent and working poor, I have learned to use captopril as my ACE inhibitor of choice for hypertension - because it is generic, very inexpensive, and works at a twice a day dosing for hypertenion. Should I switch to a more expensive antihypertensive?

This is a very serious issue. I will try to stay aware of the developments, but if I miss them, and you see them, please let me know.