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Prescription limits under Medicaid a major concern

Advocates for diabetes patients are voicing concerns that Medicaid cuts taking effect in February will reverse gains South Carolina has made over the past decade in managing diabetics' health.

Doctors have treated diabetes aggressively in recent years, but cuts in the number of drugs Medicaid covers - reductions state health officials called difficult but necessary - might compromise that focus, they said.

The number of diagnosed cases of adult-onset diabetes has risen dramatically, but the rate of lower-extremity amputations has decreased, according to preliminary findings from the annual report of the Diabetes Initiative of South Carolina.

The group, an independent research and outreach group established by the Legislature in 1994, plans to release its full report by March.

Another key finding shows that fewer diabetics are turning to hospital emergency rooms for treatment, said Dr. Daniel Lackland, chairman of the Diabetes Initiative.

Lackland, a professor in the neurosciences department of the Medical University of South Carolina, attributes the gains to patients' heightened awareness about how to manage the disease.

"They're going to the doctor, and the doctor is making sure they get under treatment quickly," Lackland said. "They're aggressively treating it. They're keeping their blood sugar down and preventing adverse effects."

Lackland and his colleagues said this week they are anxious about how the upcoming cuts will affect this progress. They said the gravest of the cuts involves the reduction in the maximum number of prescription drugs Medicaid will cover. In February, the maximum will be reduced from eight to seven, according to the S.C. Department of Health & Human Services.

Diabetics often have other health issues - high cholesterol, hypertension and heart disease, for example - that also require medication.

"This is a major challenge for us because now the clinician has to prioritize" which drugs patients should take when they cannot afford them all," Lackland said. "We don't want to see a return to the amputations. We have to emphasize that it's a whole lot cheaper to treat the disease than to treat the bad outcomes."

In addition to poor circulation, diabetics also have high risk for stroke and heart attack, among other ailments, he said.

State officials defended the cuts:

"We had to make some very difficult decisions," said Melanie Giese, a state Health and Human Services bureau chief who also is a Diabetes Initiative board member.

Added Health and Human Services spokesman Bryan Kost: "There weren't a lot of places the agency could go."

Other Medicaid cuts affecting diabetes patients to take effect in February include:

Insulin pumps, small implants that infuse insulin into the body and are used instead of shots, no longer will be covered for patients with type 2 diabetes.

Podiatry visits no longer will be covered.

The number of pairs of diabetic shoes covered will be reduced from two to one.

The number of pairs of customized diabetic shoe inserts will be reduced from six to three.

In April, the co-pay Medicaid requires for office visits to health providers will be increased from $3 to $3.40, according to the state.

All told, the cuts are expected to save $4.5 million in the current budget year and $15 million in the next budget year, Kost said.

About diabetes

South Carolina ranks 10th nationally in the percentage of population with diabetes, according to the most recent statistics from the state Department of Health and Environmental Control.

In the Palmetto State:

Diabetes is the seventh leading cause of death.

Medicare and Medicaid paid for more than two-thirds of the total hospital costs associated with diabetes.

Diabetes hospital costs have increased by 50 percent in the past five years.

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