LOUISVILLE — Two new laws have helped make Kentucky's Medicaid program the nation's leader in spending on prescription antacids, while the total amount spent on prescription medicine for the state's Medicaid recipients has jumped for the second consecutive year.

        Pharmaceutical spending rose from $433 million a year ago to $568 million in the fiscal year that ended June 30 — an increase of 31 percent. That followed a 24 percent increase the previous year.

        Only nursing home care, at $570 million last year, cost Medicaid more than prescription drugs.

        The program last year spent more on the three most expensive name-brand antacids than it did for dental care. A University of Kentucky analysis found it could save $10 million by switching to lower-priced generic alternatives — but the laws won't allow the state to do so.

        The bills passed in 1998 and 2000 virtually eliminated the power of Medicaid officials to limit the use of the newest and most expensive name-brand drugs. An effort to repeal the bills failed this year.

        State Sen. Daniel Mongiardo, a Hazard physician and chairman of a legislative committee that oversees Medicaid, said lawmakers must reverse those two laws when they meet next year, or patients will suffer the consequences when the state is forced to eliminate a Medicaid deficit projected to be $280 million this fiscal year.

        “We're either going to have to get pharmaceutical costs under control or cut patients out of Medicaid,” said Dr. Mongiardo, a Democrat. “I see it as one or the other. You're either going to be for the pharmaceutical industry or the people of Kentucky.”

        Medicaid is the federal-state program that helps pay for health care for the needy, elderly, blind and disabled, and for low-income families with children. In Kentucky, the program this year had served 567,276 people as of June 30, 9 percent more than two years earlier.

        Dr. Robert Hughes, a Murray physician and chairman of a board that oversees prescription drugs for Medicaid, said the two laws have stripped his board of its power to require the use of cheaper, generic drugs unless a doctor or pharmacist obtains prior approval from Medicaid for the costlier, name-brand drugs.

        At issue are two bills lawmakers say were pushed through with the help of the state's powerful pharmaceutical lobby.

        The 1998 bill, Senate Bill 351, required Medicaid to make all new drugs available without restrictions during their first 12 months on the market — typically, when medicines are most expensive. Sen. Joey Pendleton, a Hopkinsville Democrat, has said he sponsored the measure at the urging of the pharmaceutical lobby but would be willing to reconsider it.

        Last year, a bill sponsored by Sen. Julie Rose Denton, a Prospect Republican who is chairwoman of the Senate Health and Welfare Committee, further opened the door by requiring Medicaid to make all similar drugs available without restrictions when a new drug comes on the market.

        Earlier this year, the House passed a bill to repeal the two laws, but it stalled in the Senate and died after Ms. Denton declined to hear it in her committee.

        UK pharmacy Professor Clifford E. Hynniman, who consults with state Medicaid officials on pharmaceutical issues, said he and Medicaid officials tried but failed to persuade Ms. Denton to back the bill — finding themselves outnumbered and outmaneuvered by the pharmaceutical lobby.

        Lobbyists sat in on nearly every discussion with Medicaid officials — even when state officials thought they had scheduled a private meeting with Ms. Denton, Mr. Hynniman said.

        Ms. Denton said she's willing to reconsider the bill if it would help contain the costs of pharmaceuticals. She said she believes the program should look at other ways to control pharmacy costs, such as better management.

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