Health and Medical News and Resources

General interest items edited by Janice Flahiff

States Crack Down on Mental Health Prescriptions

 

From the 14 August 2012 edition of Stateline

n the past two years, Illinois has done just about everything it could to reduce the amount it spends on prescription drugs for mental health. It has placed restrictions on the availability of 17 medications used to treat depression, psychosis and attention-deficit disorder. Doctors now have to explain to Medicaid why the drugs are necessary before a patient can get access to them. Then in July, as part of an effort to cut overall Medicaid spending by $1.6 billion, the state capped the number of prescriptions for Medicaid recipients to four a month, even if they previously were taking a broader cocktail of behavioral medications.

In financial terms, there is no question that it has worked. Last year, the state’s Medicaid mental health drug spending budget was reduced by $112 million. The new cap on prescription drugs is expected to save another $180 million.

Up until 2011, behavioral health drug spending made up about a quarter of Illinois’ Medicaid prescription drug costs. The state spent about $392 million that year on drugs for treating mental health patients. In fiscal 2012, the state spent $280 million on mental health drugs.

But what are the implications for quality of care? Some physicians argue that they are disastrous. “It’s a mess,” says Dr. Daniel Yohanna, a psychiatrist at the University of Chicago Medical Center.  “People who were stable on some drugs have been unable to get them. It has created a significant problem.”

Michael Claffey, of the Illinois Department of Healthcare and Family Services, says the state is aware of the complaints from the mental health community, but adds, “we don’t have unlimited funds. We need doctors to work with us…If a patient needs a drug, they will get approval.”..

..

About half of Medicaid mental health patients had difficulty accessing at least one medication, and about a quarter of them then stopped taking their medications, according to a Psychiatric Services report in 2009 on physicians’ experiences in 10 state Medicaid programs. Physicians reported that many patients experienced an adverse event, such as hospitalization, homelessness or even suicide because they couldn’t get their drugs.  Another study, reported in the May 2008 issue of Health Affairs, showed that between 2003 and 2004, Maine’s prior authorization program for atypical antipsychotics (drugs that treat serious psychoses) resulted in a 29 percent greater risk that patients suffering from schizophrenia would fail to follow their treatment protocol.

Competing studies, on the other hand, suggest that mental health drugs aren’t being properly prescribed, particularly to those under 18, and that imposing restrictions can improve quality of care by requiring physicians to reconsider why they are writing a prescription. I..

In Illinois, Yohanna says he has seen examples of inappropriate prescribing of psychotropic drugs and agrees that “prior approval can help with that.” But he thinks that requiring all doctors to get approval for drugs “is just throwing a blanket on things without really dealing with the worst offenders.” He says a policy like Washington State’s second opinion program would be a good idea, as well as setting up a system where there are fewer restrictions on doctors who had responsible prescribing patterns. Currently Yohanna says, it can take two to three days to get a drug approved.

 

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August 15, 2012 - Posted by | Public Health | , , ,

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