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Through ongoing communication with mental health professionals and public officials, we are seeking to improve and expand mental health services. We advocate for statewide mental health reform, equitable medical insurance, affordable housing, employment and civil liberties.

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OP-ED 2/22/09

OMAHA WORLD HERALD

Bill To Repeal Mental Health Drug Exemption Places Medicaid Patients at Risk

By Daniel R. Wilson, MD, PhD, Sidney A. Kauzlarich, MD, and Linda Jensen, RN, PhD

Nebraska has a disheartening track record when it comes to the care and treatment of its residents with mental illnesses.  Consider the state’s Safe Haven Law. More than 90 percent of 34 children ages 3 to 17 abandoned at Nebraska hospitals were found to be challenged by a mental health disorder. Throughout the state, access to the intensive mental health services that children and their families need is lacking.  This is underscored by the controversy surrounding the Beatrice State Developmental Center, which closed its medical hospital in May 2008 to save costs, and was forced to transfer its medically fragile residents to private hospitals.  And, while the state is developing effective community-based services for adults with mental health needs, Nebraska is late to the game.  Long after a national move to transform to recovery oriented community care, Nebraska has few peer run services. 

Now Nebraskans with mental health disorders face a new threat.  A legislative bill— LB 661 — would repeal the exemption of psychiatric drugs from the state Medicaid Prescription Drug Act’s preferred drug list (PDL).  The danger here is that many of the clinically preferred drugs for serious mental health disorders will be excluded from the PDL, thereby limiting access to the very medications that help many successfully manage their mental health conditions.

The impact on Medicaid recipients with mental health disorders could be devastating.  A study of dual-eligible Medicaid and Medicare Part D patients published in the American Journal of Psychiatry in May 2007 found that among individuals with mental illnesses who were switched to a different prescription because the clinically preferred mental health medication was not covered or approved, one in three had an emergency room visit and more than 15 percent were hospitalized.  Nearly 22 percent of these patients experienced suicidal thoughts or behavior, and 14.5 percent experienced a rise in violent thoughts and behavior.

A Harvard Medical School Study published online last April by Health Affairs uncovered similarly troubling results for Maine Medicaid patients with schizophrenia.  After the state imposed prior authorization requirements on the drugs used to treat the disorder there was a 29 percent greater risk of treatment discontinuity for 30 days. Study author Harvard Professor Stephen B. Soumerai cites research indicating that 80 percent of patients with schizophrenia suffer a relapse when they go off of their antipsychotic medications, which may result in increased emergency room visits, hospitalizations, homelessness, and/or violence. “It is more difficult to place restrictions in the arena of chronic mental illness,” Soumerai wrote. “The populations you’re treating are highly vulnerable, and the various drugs work differently on different patients.”

The intent of Nebraska’s LB 661 is understandable— to control medical costs.  However, in the case of the Maine Medicaid patients, the study found that the restrictions saved only $2.33 per patient per month and did not calculate other costs such as increased hospitalizations, extra law enforcement, judicial and correctional services that would be incurred by Nebraska taxpayers. 

When it comes to controlling health care spending, drug costs are the least of the problem. The Centers for Medicare & Medicaid Service reports that U.S. prescription drug spending increased 4.9 percent in 2007—the lowest growth rate in 45 years—while the growth rate for health care spending overall was 6.1 percent.  This was principally driven by high generic dispensing rates—from 19 percent of all U.S. prescriptions in 1984 to 64 percent in 2008.  For example, , the average price of SSRIs (newer antidepressant medications commonly prescribed for major depression and anxiety disorders) declined from $108.49 per prescription in 2000 to $62.95 in 2007. The marketplace is accomplishing what the Medicaid Prescription Drug Act set out to do, to reduce prescription drug costs—without depriving individuals of the medications that work for them.

Now is the time for lawmakers to take a stand against LB 661.  People with serious mental illness, especially those who depend on Medicaid, need access to a full range of medications to assist in their recovery.  By restricting low-income patients’ access to psychiatric medications, preferred drug lists can limit recovery and cost Nebraska taxpayers far more than they save in prescription drug spending.  No one wants that.

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Daniel R. Wilson, MD, PhD, Creighton University Chair of Psychiatry, is immediate Past President of the Nebraska Psychiatric Society.

Sidney A. Kauzlarich, MD, President Nebraska Psychiatric Society, Assistant Professor, UNMC Department of Psychiatry and Creighton University Department of Psychiatry. 

Linda Jensen RN, PhD, is President of the National Alliance on Mental Illness (NAMI) Nebraska, a grassroots organization for people with mental illness and their families. NAMI members work to provide support, education and advocacy.

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