NAMI E-News March 12, 2003 03-10
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Medicaid Malpractice
NAMI today issued a statement and press release entitled
"Medicaid Malpractice - States Put Patient Recovery At Risk By Restricting
Prescription Drugs". The statement expresses strong concerns about policies
either being instituted or considered in 45 states to restrict access to
psychiatric medications in state Medicaid programs. The statement also
describes NAMI's 10 point policy for federal and state action for federal and
state action to prevent these "penny wise but pound foolish" restrictions. The
text of the statement follows.
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MEDICAID MALPRACTICE
States Put Patient Recovery At Risk
By Restricting Prescription Drugs
NAMI Policy Research Institute Releases 10-Point Policy To Ensure Access to
Effective Medications in State Medicaid Programs
Arlington, VA—The National Alliance for the Mentally Ill (NAMI) today released
a 10-point policy prescription for State Medicaid programs to ensure access to
effctive medications for people with severe mental illnesses—challenging moves
by states to save money by restricting drug benefits.
“These ten points call for Federal and state action,” said Michael
Fitzpatrick, director of NAMI’s Policy Research Institute (NPRI). “In too many
cases, current state initiatives to control drug costs are penny wise, but
pound foolish. Too many times in the past, people with mental illnesses have
been neglected or abandoned—at a terrible cost. As a society, we know how to
treat mental illnesses, but too often, the investment is too little, too
late.”
“Restrictions on access to effective medication are acts of budget
desperation— not enlightened leadership. They will compromise recovery and
lead to greater costs elsewhere. They represent bad medicine and Medicaid
malpractice.”
“States are not putting the interests of patients first.”
Approximately 45 states are instituting or considering restrictions on
Medicaid drug benefits—through preferred drug lists, fail-first requirements,
pill- splitting, increased co-payments and other measures. The cost of
prescription drugs has increased an average of 18 percent since 2000, and is
considered the most significant factor responsible for increased Medicaid
costs.
The NAMI program includes support for the National Governors Association in
seeking to increase the Federal Medical Assistance Percentage (FMAP) for
Medicaid.
Debate over drug restrictions has been especially fierce this year in
Colorado, Florida, Georgia, Illinois, Iowa, Massachusetts, Mississippi,
Nevada, New Jersey, New York, New Mexico, Ohio, Oklahoma, Oregon, South
Carolina, Texas, Tennessee, Washington, West Virginia, Vermont, and Virginia.
“The debate will extend well beyond 2003,” Fitzpatrick said. “Anyone who
thinks this year is bad should wait until 2004. Legislatures are undermining
doctor- patient relationships and the exercise of professional judgment.”
Text of 10-Point Program Attached
With more than 220,000 members and 1200 state and local affiliates, NAMI is
the nation’s largest grassroots organization dedicated to improving the lives
of people with severe mental illnesses. Funding sources for NAMI programs
include hundreds of state and local governments and foundations; tens of
thousands of individual donors; and a growing number of corporations. NAMI’s
greatest asset, however, is its volunteers—who donate an estimated $135
million worth of their time each year to education, support and advocacy. NAMI
does not endorse any specific medication or treatment.
MEDICAID ACCESS TO EFFECTIVE MEDICATIONS
NAMI Policy Research Institute
March 2003
Prior Authorization Threatens Consumers’ Health
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.
NAMI Policy Research Institute’s Prescription to Ensure Access to
Medications
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.
Federal Strategies
1. NAMI supports an increase in the “Federal Medical Assistance Percentage,”
or FMAP to get states through these difficult financial times. Cutting back on
Medicaid spending by states will result in severe service, infrastructure and
community impacts due to the loss of federal funds. We are supporting efforts
of the National Governors Association and other groups to increase the
Medicaid matching rates.
2. NAMI supports appropriate, emerging legislative initiatives to expand
prescription drug coverage for Medicare beneficiaries. We believe that state
pressure to control prescription drug spending will mount in the absence of a
Medicare drug benefit.
3. NAMI supports system-wide health care reform to reduce fragmentation in the
delivery of mental health services and to ensure access to the most effective
treatments.
4. NAMI supports increased funding allocations to the National Institute for
Mental Health (NIMH) to gain better insights on access to new medications and
supports increased funding for research on evidence-based practices.
State Strategies
5. When it comes to medications, particularly for mental illnesses, one size
clearly does not fit all. Each person can react differently to anti-psychotic
or anti-depressant medications both in terms of efficacy and potentially
dangerous side effects. NAMI opposes the use of Medicaid prior authorization
programs to control prescription drug costs and utilization. NAMI believes
that Medicaid prior authorization programs are high-risk cost containment
strategies and they are not an effective cost-management strategy based on
private sector experience. The most cost effective and humane solution is to
respect the roles of the practitioner and consumer to select the treatment
that works best.
6. If prior authorization programs are in place or being strongly considered,
NAMI supports carve-outs for anti-psychotic, anti-depressant, anti-anxiety and
anti-convulsant medications from restrictive cost control programs in order to
ensure that people with mental illness have open access to medications that
maintain recovery.
7. NAMI supports research efforts by pharmaceutical companies to develop new
medications but opposes pricing practices that make these medications
unaffordable.
8. NAMI supports the development of notification, grievance and appeals
procedures to protect Medicaid recipients with serious mental illness.
9. NAMI will participate, as appropriate, in class-action suits, and file
amicus briefs, that would oppose restricting Medicaid clients’ access to
prescription drugs through prior authorization programs.
10. NAMI supports “Polypharmacy Education Programs” that are aimed at reducing
the over prescribing of medications as an alternative to restrictive cost
containment programs and the development of explicit treatment protocols with
rigorous follow-up assessments.
Conclusion
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.
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