TALLAHASSEE, Fla. (Cox News Service) - Social services advocates were gearing up for a public relations battle as word spread about a Senate plan to include prescription drugs for AIDS patients and the mentally ill in sweeping Medicaid reforms.

With Medicaid costs soaring and state revenue growth sputtering, lawmakers have ordered the Agency for Health Care Administration to find ways to cut $281 million from the budget that buys prescription drugs for poor people.

It's a relatively small amount compared with the roughly $50 billion state budget and the $8.3 billion Medicaid program.

But it is also a politically sensitive issue when Gov. Jeb Bush and House Republicans have proposed more than $300 million in tax cuts, mostly to stock and bond holders.

"The bottom line is money," said Jaunita Hernandez-Black, president of the Mental Health Association of Central Florida in Orlando. "I applaud the state for looking at ways to save money. . . . But we're dealing with people's lives."

Last year, the legislature created a law that limits the amount of brand-name drugs that individual Medicaid recipients can receive to four per month, with no limit on generic drugs.

However, the law exempted antiretroviral agents used to treat AIDS and other drugs used to treat chronic mental illness, such as depression, bipolar disorder and schizophrenia.

A bill (SB 792) that passed the Senate Health, Aging and Long-Term Care Committee on Thursday weakens the exemptions by tying them to a "restricted drug formulary" that has yet to be created and "prior-authorization" by a third-party administrator.

Sen. Ron Silver, D-Miami, who sponsored the measure, was traveling Friday and not available for comment.

The state estimates that there are 14,000 AIDS patients on the Medicaid rolls and another 40,000 on the rolls receiving drugs for mental illness.

"Both of these groups are very high-cost patients," said Jerry Wells, pharmacy program manager for the agency. "The drugs that they get are a big chunk of the budget."

Wells said it is unlikely that AIDS patients would be denied prescriptions because alternatives are hard to find. Regulators also would be hesitant to switch prescriptions for mentally ill patients if the regime is working.

"What you do is get doctors thinking about the next patient" and the possibility of successful treatment with cheaper alternatives, he said.

Switching drug therapy for mental health patients could be dangerous because it can take up to six weeks to find a drug or combination of drugs that work, Hernandez-Black said.

The group is planning a news conference on Tuesday in Orlando to criticize the proposal.

"They could have a psychotic break. If that happens, they could end up in the hospital. Do you know how much more expensive that could be?"

Rep. Jerry Maygarden, R-Pensacola and chairman of the House social services spending committee, also is scrambling to cut Medicaid prescription costs, although the House plan does not suggest changing the AIDS and mental health prescription exemptions.

"We have got to do a better job both managing chronic mental illness and limiting the price that we pay for these drugs," Maygarden said.

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