To control pharmaceutical spending and to attempt to control their budget expenses, a number of states have adopted or are considering restrictions on access to certain types of expensive medications, including psychotropic medications, in their Medicaid programs. States will be attempting to control drug costs in several ways such as placing certain drugs on a list requiring prior authorization before dispensing -- and requiring as a prerequisite for authorization of a specific, often non-formulary medication – that the patient fail on at least one other medication.
These prior authorization initiatives 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, these programs will jeopardize consumer health if they restrict access to needed medications.
Based on data from Florida and Michigan thousands of Medicaid recipients have left the pharmacy without filling their prescriptions due to the prior authorization programs.
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. 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.
In response to the developing threats to access to medications for people with serious mental illness, the NAMI Policy Research Institute’s Access to Medications Task Force was created and charged by the Board of Directors to examine the available evidence and provide policy guidance on this issue to the NAMI Board, NAMI's grassroots; advocates, and policymakers.
Based on the task force deliberations, NAMI recommends the following 10-point program to ensure open access to medications in the current budget deficit environment. This program is an integrated, comprehensive approach to addressing the needs and interests of the people with serious mental illnesses who need access to medications for recovery.
NAMI remains opposed to state policy changes that put costs ahead of consumer health care and stands ready to work with states to find real solutions to current budget problems. NAMI looks for every opportunity to work with state and federal policymakers and to ensure that limited public dollars are used in the most effective way to protect access to the most effective treatments for people with serious mental illnesses. We encourage policymakers to consider a comprehensive and coordinated effort to address the needs of people with serious mental illness to prevent long-term damage to an already inadequate system of care.