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Phil Kabler: Drug cost estimate raises eyebrows

CHARLESTON, W.Va. -- Ted Cheatham, executive director of the state Public Employees Insurance Agency, had stayed out of the headlines of late. That's what happens when you manage a health insurance plan that's going into it's third straight year without a premium increase.

However, that changed last week when Cheatham was asked at a legislative interim committee meeting to discuss what impact proposed legislation to make antihistamines containing pseudoephedrine available by prescription only would have on PEIA's expenses.

Cheatham raised eyebrows when he told legislators PEIA actuaries advised the cost could run about $4.3 million a year -- $500,000 for costs of the prescriptions, and $3.8 million for the increase in visits to doctor's offices.

Those of us who look at lots of fiscal notes know that, historically, the default mode for many agency heads is worst-case scenario. (Most famous was the $1.5 billion Department of Education fiscal note for a bill to require daily physical education classes for all students, which assumed the need to build new gyms and athletic fields at all schools.)

In fact, Cheatham subsequently said the cost estimate assumes the Legislature not only made Sudafed prescription-only, but also made it a Class II controlled drug, with 30-day, unrefillable prescriptions, requiring separate doctor's visits for each 30-day supply.

However, as House Health and Human Resources Chairman Don Perdue, D-Wayne, points out, none of the variations of bills to make pseudoephedrine prescription-only would make it a Schedule II controlled substance.

The version that's gotten the farthest (HB2946), which passed the House in the 2011 regular session, and died on a dramatic 16-16 tie in the Senate, would have made it a Class III drug. (Then-Senate President Earl Ray Tomblin was acting as governor at the time, and did not vote, and then-Sen. Walt Helmick  took a pass to attend a grandson's birthday lunch.)

That classification, Perdue notes, would have permitted a 30-day prescription with up to five refills, meaning a maximum of two doctor's office visits a year, not 12.

(PEIA's fiscal note on the 2011 bill estimated costs as high as $800,000, but probably closer to $400,000, presuming that many cold and allergy suffers would opt for an over-the-counter alternative rather than going to the doc for a Sudafed script.)

I was privy to some email exchanges between Perdue and Cheatham on the issue, including this one from Cheatham:

"Again, I must reiterate as I did in the committee meeting, this was the first response from the actuary.  It is indeed a worse case, conservative scenario. We have not looked at a bill or the refill issue. I just explained the assumptions the actuary used to create these numbers. I would be happy to have the actuary model the scenarios you foresee. Please share your thoughts on needed physician visits and refill guidelines and we will run the scenarios."

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While lobbyists for Big Pharma will make hay over how unfair it is to make law-abiding citizens visit the doctor to get a pseudoephedrine prescription, one issue not mentioned is that folks taking Sudafed on a daily basis for extended periods of time most likely have chronic conditions that do require a physician's attention.

The package of over-the-counter antihistamine I have sitting at home, for instance, advises seeing a doctor if symptoms persist for two weeks.

Perdue, a pharmacist by trade, speaks from personal experience. He said he had chronic sinus congestion which he self-treated for years with Afrin.

"Had I simply seen an EENT (eye, ear, nose and throat specialist) early on, the symptoms of Wegener's disease, which often starts with sinus issues, may have been noted much sooner, and I mightn't have had peripheral neuropathy and other things today," he said.  

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Finally, as you may know, one of my joys in life is to get the word "ironically" in print -- particularly if I can misuse it for "coincidentally."

However, "ironically" would be an entirely appropriate word Thursday, when the state Ethics Commission violated the state Open Meetings Act by failing to post public notice of the commission meeting, and of its Open Government Committee meeting (which, ironically, deals with issues regarding compliance with the open meetings law) in the online State Register.

The commission has had a lot of staff turnover of late, and the posting of the meeting notices slipped everyone's attention. That means a lot of do-over votes when the commission next meets, in February, since none of the actions taken Thursday can be official.

Coincidentally, the lack of public notice meant I missed the debut of former secretary of state Betty Ireland as a commissioner, and no doubt, she'll be a strong -- and outspoken -- addition to that panel. Other new members appointed by Gov. Earl Ray Tomblin in time for the December meeting were Marie Redd, a former Democratic state senator from Cabell County; Michael Greer, a former Republican delegate from Harrison County (and former original member of the Ethics Commission, now on a second tour of duty); and Moundsville resident Suzan Singleton, a member of the West Virginia Municipal League. 

Reach Phil Kabler at philk@wvgazette.com or 304-348-1220.


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