The mentally ill, effective meds, and Medicaid
The mentally ill, effective meds, and Medicaid
State and federal governments need to ensure continued access to effective medications for people with severe mental illnesses even though Medicaid programs are trying to save money by controlling prescription drug use, according to the National Alliance for the Mentally Ill (NAMI) in Arlington, VA.
Michael Fitzpatrick, NAMI Policy Research Institute director, says the group’s recommendations need to be followed because "in too many cases, state efforts to control drug costs are penny-wise and pound-foolish. Too many times in the past, people with mental illnesses have been neglected or abandoned, at a terrible cost. As a society, we know how to treat mental illnesses, but too often, the investment is too little, too late. Restrictions on access to effective medication are acts of budget desperation not enlightened leadership. They will compromise recovery and lead to greater costs elsewhere. They represent bad medicine and Medicaid malpractice."
NAMI says that some 45 states are considering or instituting restrictions on Medicaid drug benefits through preferred drug lists, fail-first requirements, pill-splitting, increased copayments, and other measures.
A number of states have adopted or are considering restrictions on access to certain types of expensive medications, including psychotropics. NAMI says the various types of prior authorization restrictions can pose significant threats for Medicaid recipients with serious mental illnesses trying to access medications prescribed by their treating physician.
"While NAMI understands that states must make tough decisions in the face of the current budget crisis," the group’s report says, "these programs will jeopardize consumer health if they restrict access to needed medications.
"It is clear to the NAMI Policy Research Institute that the consequences for people with serious mental illness will be devastating if Medicaid prior authorization programs and other cost-control initiatives become more commonplace," the report continues.
"Based on costs rather than health and safety, prior authorization programs, preferred drug lists, and fail-first procedures often force physicians and consumers to choose medications that they would otherwise not prescribe. Restrictions on access to psychotropic medications not only jeopardize consumer health, but they fail to reduce overall health costs. Multiple studies have shown that in the long run, such policies actually increase costs in hospitalization as well as emergency and primary care."
NAMI’s 10 recommendations cover:
- an increase in the federal Medical Assistance Percentage to help states cope with the current difficult budget times;
- legislative initiatives to expand prescription drug coverage for Medicare beneficiaries;
- systemwide health care reform to reduce fragmentation in the delivery of mental health services and ensure access to the most effective treatment;
- increased funding allocations to the National Institute for Mental Health to gain better insights on access to new medications and research into evidence-based practice;
- opposition to state Medicaid prior authorization programs;
- carve-out programs for anti-psychotic, anti-depressant, anti-anxiety, and anti-convulsant medications if there are prior authorization programs;
- research by drug companies to develop new medications, but with opposition to pricing practices that make new medications unaffordable;
- development of notification, grievance, and appeals procedures to protect Medicaid recipients with serious mental illness;
- participation in class-action suits to oppose restrictions on Medicaid clients’ access to prescription drugs through prior authorization programs;
- support for "polypharmacy education programs," which are aimed at reducing the overprescribing of medications as an alternative to restrictive cost-containment programs and development of explicit treatment protocols with rigorous follow-up assessments.
Mr. Fitzpatrick tells State Health Watch that the medications taken by those with mental illness often are different from those taken by people with medical problems in that psychiatrists often need to try several of the new so-called atypical medications with patients until they find one that is effective and with tolerable side effects so that the patient will be willing to take the medication.
"NAMI and other advocates fought for years for these drugs," he says, "so that side effects can be controlled and people will take them."
When states make use of preferred drug lists or fail-first requirements, he says, psychiatrists don’t have the opportunity to get to the best medication for the patient.
Among the 10 recommendations, according to Mr. Fitzpatrick, NAMI particularly is involved in working at the state level to oppose any efforts to go to a fail-first requirement. And if states do intend to institute a pre-authorization, NAMI will urge that mental health medications be carved out.
Treating life span illnesses
When asked how he justifies treating mental health medications differently, Mr. Fitzpatrick points out that schizophrenia is a "life span illness" and that when patients don’t get the specific medication they need, their life "is a disaster."
It is similar to the case made by HIV/AIDS patients, he says, in that if you don’t get the medication you die. "Policy-makers have some understanding of this need," he tells State Health Watch.
Mr. Fitzpatrick says it can be difficult to argue NAMI’s case because the battle takes place at several venues — governors’ offices, legislative halls, the media, and the public police arena. "It’s a hard thing to get your arms around," he says, "unlike some things that are just legislative issues."
[For more information, go to: http://www.nami.org. Contact Mr. Fitzpatrick at (207) 353-9311.]
State and federal governments need to ensure continued access to effective medications for people with severe mental illnesses even though Medicaid programs are trying to save money by controlling prescription drug use, according to the National Alliance for the Mentally Ill (NAMI) in Arlington, VA.Subscribe Now for Access
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