The S.C. Department of Health and Human Services released the first draft of a list of drugs that cannot be prescribed to Medicaid recipients without agency approval.

Agency officials say the plan is not intended to deny treatment, and patients won't have difficulty getting drugs that aren't on the list. They say doctors will merely have to make a phone call asking permission.

Patient advocates, however, are concerned anything that hinders access to drugs can be detrimental for patients who need them. Some advocates have lobbied to exempt certain classes of drugs, such as those used to treat mental illnesses, from the list.

The list, posted on the agency's Web site Friday, was released to give South Carolinians the chance to comment before the drug plan takes effect. The committee of pharmacists and physicians that selected the drugs will review public comments before releasing a final list July 1.

The process for creating the list had several steps. First, the committee determined which prescription drugs are the most effective. Most of the remaining drugs -- those that weren't deemed to be the best -- were placed on the list of drugs that need prior approval.

Dave Almeida, executive director for the National Alliance for the Mentally Ill-South Carolina, said the list is good and bad.

He's pleased that drugs used to treat disorders such as psychosis and schizophrenia aren't on the list. He also praises the agency for not requiring people already taking medications on the list to get approved again. But he's concerned that some of the drugs listed, such as Effexor and Zoloft, are standard first-line treatment.

"You're talking about some really good medications that aren't on the preferred-drug list," said Almeida, who plans to submit his thoughts to the agency. "That's a concern."

Gov. Mark Sanford approved the state's preferred-drug plan in February in an effort to keep runaway prescription drug costs in check. Drug costs in South Carolina are rising as much as 25 percent each year, and are about $418 million in state and federal funds.

Sanford has said the drug list would save as much as $40 million in state and federal funds a year. That's because companies with drugs on the list can negotiate rebates, lower prices or pursue other incentives to have the drugs removed.

The 136 drugs on the list treat a range of ailments, from gastrointestinal problems to allergies to back pain. Fourteen drugs used to treat mental illnesses such as depression are listed, but people already taking these drugs will not need authorization to continue on their medicine.

"This was never designed to be anti-treatment," said agency spokesman Frank Adams. "It's designed to get the exorbitant drug prices down."

The agency has had a prior authorization process in place for several years for drugs that treat arthritis and ulcers.

The company that processes the requests, First Health Services Corp., staffs a 24-hour-a-day, seven-day-a-week phone line for doctors' offices wanting to prescribe a drug that needs authorization. Adams said there have been no problems with access.

Jane Wiley, legislative director for AARP, said the list doesn't seem to place a real hardship on Medicaid patients. She hopes it can help the state cut costs.

"I know a lot of states are doing this," she said. "Our only concern is that it not interfere with the doctor's choice of treatment for a patient."