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Facts on Access to Medications for People
with Depressive, Bipolar and Anxiety Illnesses

The Patient’s Individuality

  • Most medication choices to treat depressive, bipolar and anxiety disorders require both knowledge about the specific patient and professional judgment.
  • Proper medications and dosages for these disorders depend on the age of the patient, gender, family history, the chronic nature of the illness and the general health status of the individual.
  • The choice of medication by the physician should be evidence-based and consistent with practice guidelines and take into account unique patient characteristics.
  • Differences in drug metabolism related to ethnicity, as well as cultural influences on patient and caregiver attitudes are also important factors in the successful treatment of many illnesses, including depressive, bipolar and anxiety disorders.
  • Restrictive formularies may discriminate against those patients who need alternate medication choices because of genetic factors

Figure 1.

Denying Medications to People with Mental Illness $hifts Costs to Other $ystems

  • 20% of the Prison Population Has a Mental Illness
  • 46% of the Homeless Population Has a Mental Illness
  • 25% of all Admissions for Emergency Medical Services and Hospitalizations are People with Mental Illnesses
  • 80% of Children Entering the Juvenile Justice System Have a Mental Illness
  • 26% of Social Security Insurance Beneficiaries Have a Mental Illness, Reflecting a 90% Unemployment Rate Among People with Mental Illnesses
  • It is critically important to maintain physician and patient choice in order to find an effective treatment, as quickly as possible, thus achieving the best possible clinical outcome and avoid much higher costs downstream in the form of emergency department visits, hospital stays and crisis management, (Figure 1).
  • Patients are less likely to adhere to treatment on medications that are not best for them and without supporting services, and are more likely to suffer a serious episode.
  • Financial or procedural barriers to medication access should be avoided for the most vulnerable populations such as people with major depression, bipolar disorder, and anxiety disorders. Careful selection of medications can prevent severe illness, hospitalization or death.
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  • People with these disorders often do not respond to the first or second medication regimen because of idiosyncratic differences between patients. It is often impossible to predict which medications will ultimately will be effective.
  • Such patients have notoriously poor compliance with medication regimens so any changes in medications are likely to disturb fragile and biologic equilibriums, resulting in an expensive exacerbation of the illness, (Figure 2).

Next Page: Restrictive Formularies are Bad Economics for States

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