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                                                      PRINTER'S NO. 4713

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE RESOLUTION

No. 745 Session of 2002


        INTRODUCED BY MANN, FLICK, MELIO, CALTAGIRONE, SANTONI, O'BRIEN,
           KENNEY, SCAVELLO, BROWNE, FORCIER, HARHART, DALLY, CRUZ,
           YOUNGBLOOD, LEDERER, KELLER, McGEEHAN, MANDERINO, YUDICHAK,
           STURLA, STEELMAN, CURRY, MICOZZIE, ADOLPH, CIVERA AND BARRAR,
           NOVEMBER 26, 2002

        INTRODUCED AS NONCONTROVERSIAL RESOLUTION UNDER RULE 35,
           NOVEMBER 26, 2002

                                  A RESOLUTION

     1  Urging the Secretary of Public Welfare and the Governor to
     2     rescind implementation of the draft Medical Assistance
     3     Bulletin for prior authorization of COX-2 inhibitors
     4     scheduled to go into effect on January 6, 2003.

     5     WHEREAS, There is great concern among arthritis sufferers
     6  regarding a draft Medical Assistance Bulletin scheduled to go
     7  into effect on January 6, 2003, which if issued by the Secretary
     8  of Public Welfare would impose severe restrictions on access to
     9  first-line medications used in the treatment of osteoarthritis,
    10  rheumatoid arthritis and pain in the fee-for-service Medicaid
    11  program; and
    12     WHEREAS, According to the Arthritis Foundation and the
    13  National Institutes of Health, arthritis is a painful and
    14  physically debilitating chronic disease that affects one of
    15  every three Pennsylvanians; and
    16     WHEREAS, Individuals with arthritis need access to
    17  comprehensive health care that includes the so-called COX-2

     1  inhibitor medications; and
     2     WHEREAS, The new generation of COX-2 inhibitor medications
     3  was developed to treat the pain of arthritis without the
     4  gastrointestinal complications, such as ulcers and bleeding,
     5  associated with older medicines such as ibuprofen; and
     6     WHEREAS, At least 16,000 osteoarthritis and rheumatoid
     7  arthritis patients die in the United States each year due to
     8  causes related to nonsteroidal anti-inflammatory drugs (NSAIDs);
     9  and
    10     WHEREAS, In Pennsylvania, 254 patients died in 2000 from
    11  NSAIDs bleeding, at a cost of more than $4.3 million; and
    12     WHEREAS, The draft Medical Assistance Bulletin would force
    13  physicians to try nonselective NSAIDs before a COX-2 inhibitor
    14  medication for patients who are under 70 years of age; and
    15     WHEREAS, The draft Medical Assistance Bulletin is in direct
    16  conflict with the 2002 guidelines for treating osteoarthritis,
    17  rheumatoid arthritis and persistent pain from the American
    18  College of Rheumatology, American Geriatric Society and the
    19  American Pain Society; and
    20     WHEREAS, No exceptions are granted under the draft Medical
    21  Assistance Bulletin for patients with previous history of
    22  gastrointestinal upset from older NSAIDs or previous history of
    23  gastrointestinal bleeding; and
    24     WHEREAS, The draft Medical Assistance Bulletin fails to
    25  provide a grandfather provision for existing patients who are
    26  stable using COX-2 inhibitor medications; and
    27     WHEREAS, The draft Medical Assistance Bulletin lacks
    28  consistency with COX-2 inhibitor guidelines used in other
    29  commercial health plans; and
    30     WHEREAS, Medicaid programs in about half of the other states
    20020H0745R4713                  - 2 -

     1  place no restrictions on the use of COX-2 inhibitor medications
     2  because of the recognized superior safety profile of those
     3  medications; and
     4     WHEREAS, While the goal of the draft Medical Assistance
     5  Bulletin may be to reduce drug costs in the Medicaid program,
     6  the provisions with respect to COX-2 inhibitor medications may
     7  not reduce total Medicaid costs and, as suggested by the
     8  evidence, may lead to the opposite result; therefore be it
     9     RESOLVED, That the House of Representatives urge the
    10  Secretary of Public Welfare and the Governor to rescind
    11  implementation of the draft Medical Assistance Bulletin for
    12  prior authorization of COX-2 inhibitors scheduled to go into
    13  effect on January 6, 2003.












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