APA, NAMI, NMHA Raise Serious Concerns Over Multi-State Restrictions on Medications in Medicaid

Posted on February 27, 2003

Washington, D.C. - Fiscal crisis continues to lead states toward penny-wise but pound-foolish policy choices.

A handful of states are considering pooling their purchasing power to negotiate lower prices from pharmaceutical companies for medications in Medicaid. While our organizations understand 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.

As states consider scarce budget resources in 2003, the National Alliance for the Mentally Ill (NAMI), the American Psychiatric Association (APA), and the National Mental Health Association (NMHA) unite in urging policy makers to work with the mental health community to find solutions that do not come at the expense of people with mental illnesses.

Under a new proposal, Michigan, Minnesota, Vermont, Wisconsin and possibly more states plan to set up a common preferred drug list. Based on costs rather than health and safety, such programs 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 care costs.  Multiple studies show that in the long run, such policies actually increase costs in hospitalization as well as emergency and primary care.

When it comes to medications, particularly in mental health, 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. The most cost effective and humane solution is to respect roles of the practitioner? and consumer to select the treatment that works best in each case.

States such as Michigan have already chosen to enact dangerous restrictions on access to medications in their Medicaid program. As states consider developing a joint program, several concerns must be addressed. For example, what type of proof of historic failures with preferred drugs will be required before consumers can access the medications that are right for them? Will consumers be forced to switch off of stable medications that have worked well for them?
How will mental health and other key therapeutic classes be protected from harsh restrictions? How will states document cost increases in other service areas (hospitals, emergency rooms, etc.) as a result of these restrictions?

Our organizations remain opposed to policy changes that put costs ahead of consumer health care and stand ready to work with states to find real solutions to current budget problems.

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 38,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders.  For more information, visit www.psychiatry.org.

With more than 220,000 members and 1,200 state and local affiliates, the National Alliance for the Mentally Ill 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; ten 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.  For more information, visit www.nami.org.

The National Mental Health Association is the country's oldest and largest nonprofit organization addressing all aspects of mental health and mental illness.  The NMHA works to improve the mental health of all Americans through advocacy, education, research and service.