SanFranChron

State's drug costs for prisoners have soared Auditor criticizes system as outmoded

Robert Salladay, Chronicle Sacramento Bureau Tuesday, January 15, 2002

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Sacramento -- Prescription drug costs for thousands of California prison inmates and the mentally ill have skyrocketed in recent years as the state's outmoded prison pharmacy system teeters near collapse, a state auditor's report says.

Between 1996 and 2001, the cost of buying drugs for prisoners, the disabled and others under state care increased on average 34 percent every year -- three times the national rate, the report found. The state now spends about $135 million a year on prescription drugs.

While acknowledging serious flaws in the system, the state says the drugs prescribed most often -- new therapies for HIV and mental health -- are some of the most expensive on the market. The state, for example, spends $61 million a year on just two antipsychotic drugs, olanzapine and risperidone.

At the same time, the prison demand for antipsychotic and antidepressant drugs has increased 34 percent since 1999, in part because of a lawsuit requiring California to revamp how it treats mentally ill inmates, auditors said.

The report nevertheless contends that the Department of Corrections has no way of effectively tracking questionable prescriptions given to inmates. They say the department missed a key opportunity when it reviewed its drug shopping list -- called a formulary -- to also identify prison doctors who are writing too many high-cost prescriptions.

The 78-page report did not come as a shock to the sprawling Department of Corrections. The department already has hired its own private consultant to evaluate its buying program and drug-tracking system, which the department contends is "in danger of imminent failure."

"We think that most of their criticism of our system is valid," said Stephen Green, assistant secretary of the Youth and Adult Correctional Agency.

The audit also contains harsh words for the Department of General Services, which arranges most drug-buying contracts for the state. Auditors said the department had failed to negotiate enough contracts below the wholesale price and jumped too quickly into a drug-buying alliance with Massachusetts without checking other buying cooperatives.

The department said its new arrangement with Massachusetts could save taxpayers $3 million, but that it remains open to joining forces with other states. And while the state has lagged in signing contracts, it has low-cost agreements for the most-prescribed drugs, again saving the state.

Green said one of the biggest problems is the state's low pay for prison pharmacists, which the audit highlighted. A state prison pharmacist makes on average about $58,000 a year, compared to a Kaiser pharmacist at nearly $90, 000, the report said. There are 30 vacancies in prison pharmacies.

The Legislature is likely to address the issue of drug costs this year. The California Public Interest Research Group is preparing legislation to put all state agencies, perhaps including retirees in the huge public retirement system, into a drug "buying pool," similar to a system used in Minnesota.

"This has the potential to save the state quite a bit," said Jerry Flanagan with the public interest research group, "and that dollar savings could stay in health care where it otherwise would be cut in the current fiscal shortfall. "

-- Anonymous, January 16, 2002

Answers

Checked the household checkbook ledger. Since 11/30, we have forked out $1200 to the local pharmacy to keep my parents stocked up. (That's probably more than a month and a half's worth, but it's still right up there...)

-- Anonymous, January 16, 2002