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Harmful Restrictive Drug Formulary Could Set Standard For Industry
Arlington, VA - "Caution, Your HMO May Be Dangerous To Your Health," is the lead for a full-page ad placed by the National Alliance for the Mentally Ill (NAMI) in today's Sacramento Bee and in the San Diego Union Tribune and the San Jose Mercury News on Friday. The group's ad expresses distress over PacifiCare's decision to restrict access to the most commonly prescribed psychiatric medications.
Earlier this year, PacifiCare, California's second largest health maintenance organization (HMO), removed two antidepressants, Prozac and Zoloft, and one antipsychotic, Risperdal, from its list of covered drugs -- a decision which leaves consumers with few choices in drug therapy. This policy limitation will affect more than 15 percent of the 2 million members who belong to PacifiCare.
NAMI representatives fear that PacifiCare's decision is only the tip of the iceberg and that other health care providers will follow suit. "If PacifiCare is to set the standard for the rest of the industry, then we need to hold them to the highest treatment standards," says Laurie M. Flynn, NAMI's executive director.
PacifiCare's decision is based largely on financial considerations. In each instance, PacifiCare chose the cheaper drug to provide to its members. "This cost-cutting effort puts the bottom line first and individuals like my daughter, who has a severe mental illness, last," says Flynn.
NAMI believes PacifiCare's decision will prove extremely detrimental to persons with severe mental illnesses, since there is no one miracle drug which works for every consumer - each person's system reacts differently to various medications, and each medication produces different side effects.
Statistics show that nearly one of every five California families will be affected by a serious mental disorder during their lifetime. It is also reported that 15 percent of people suffering from depression commit suicide and another 40 percent consider committing suicide. Mental illnesses are brain disorders that can be effectively diagnosed and treated if access to appropriate health care, including breakthrough medications, is available.
"While PacifiCare claims effective alternatives are available, the fact is an examination of their formulary proves that they are not. What PacifiCare substitutes in the name of money are older, cheaper medications which very often are less effective and have more side effects. NAMI would like to see the newer medications reinstated immediately, because lives are at stake," Flynn said.
Physicians who choose to prescribe a medication not listed on the plan's formulary must obtain prior authorization. This process could take 24 to 48 hours, and NAMI fears that it presents an unnecessary obstacle for appropriate treatment and consigns consumers to second-class medications.
NAMI is the nation's largest grassroots organization solely dedicated to improving the lives of persons with severe mental illnesses, including schizophrenia, bipolar disorder (manic-depressive illness), major depression, and anxiety disorders. NAMI has more than 140,000 individual members and 1,140 state and local affiliates in all 50 states, the District of Columbia, Puerto Rico, and Canada. NAMI's efforts focus on support to persons with serious brain disorders and to their families; advocacy for non-discriminatory and equitable federal and state policies; research into the causes, symptoms and treatments for brain disorders; and education to eliminate the pervasive stigma toward severe mental illness.
"Open Your Mind, Mental Illnesses Are Brain Disorders."
NAMI's Campaign to End Discrimination is a five-year effort to end discrimination in insurance, housing, and employment against people with severe mental illnesses.
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