Drug companies detest such "prior authorization" requirements, saying they limit access to particular drugs and force some patients to accept inferior alternatives.

The court also appeared to accept the contention that "prior authorization" requirements could help save money for Medicaid without harming beneficiaries.

Specifically, the industry said that the prior authorization requirement would make it much more difficult for Medicaid recipients to obtain some of the drugs they needed.

The prior authorization requirement, all agree, is likely to drive doctors and patients to use similar drugs made by other companies.

Also called step protocol, a fail first requirement, or a prior authorization requirement.

After two hours, I was livid at the silliness and bugginess of this whole authorization requirement.

Drug companies detest this "prior authorization" requirement, and say it would limit access to particular drugs, forcing patients to accept inferior alternatives.

"When states impose prior authorization requirements, it puts patients who are most in need at the back of the health care line," Mr. Holmer said.

Moreover, the industry said, prior authorization requirements cause "drastic losses of market share and severely reduced sales" for the affected drugs.

Doctors find this authorization requirement onerous, so sales of drugs subject to the requirement decline precipitously.