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Utah's Medicaid patients have enjoyed unfettered access to mental health drugs, which are exempt from the low-income health program's preferred drug list.

But that exclusion undermines the drug list's potential for savings, says Sen. Allen Christensen, noting that antispychotics, antidepressants and anti-seizure medications account for more than a third of Medicaid's $176 million prescription budget.

In a penny-pinching year, "every penny counts," said the North Ogden Republican, who is sponsoring a bill to remove the exemption for mental health drugs and use some of the money saved ­— nearly $1 million ­— to prop up the budgets for county mental health clinics and to restore emergency dental services for Medicaid patients.

SB137 also would remove the exemption for anti-rejection drugs used by transplant patients.

Launched in 2008, the drug list has saved taxpayers millions by steering patients to lower-cost but therapeutically equivalent medicines. In deciding which drugs to endorse, the Utah Drug Utilization Board weighs a medicine's effectiveness, safety and cost.

It favors generic drugs, for example, and requires approval for others.

County mental health centers, which lose $615,000 in expired federal stimulus money this year, support the idea of adding mental health drugs to the list, said Christensen. But he expects some pushback from mental health advocates and the pharmaceutical industry.

"They'll paint me the bad guy when I'm trying to preserve access to mental health services," he said. "It doesn't matter what drugs you are or aren't going to get if there is no one to prescribe them."

Because drugs are a primary means of treating mental illness and getting the right mix and dose can be tough, advocates have argued against anything that might impede patient access.

But Christensen, a pediatric dentist, said patients can appeal to have their drug of choice covered.

The board, comprising doctors, pharmacists and a member of the public, takes into consideration a patient's unique physiology and often finds in favor of the patient, he said.

Indeed, a review of board meeting minutes shows that of the 20 appeals filed in 2010, 14 were approved.

Medicaid's growing share of states' budgets has made it a prime target for cuts.

On Monday, the Social Services Appropriations Subcommittee will take its first stab at the $1.8 billion program, voting on what to trim first.

"Assuming we find some money, we'll backfill where we can," said Christensen. "We're not the bad guys. We're also not the tax raisers, and you can only stretch a dollar so much until it breaks."

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