Heard in the Halls

Threat to Open Access to  Medications for Mental Illness

We are at a critical time.  There are serious threats to open access to much needed mental illness medications.  The Governor's budget is projecting major savings through cutting this line item, which means people will have to change from the drugs they are on to ones that may not work as well.  We need to make it as easy as possible for people to get the medicines they need to get well and stay well.  Help us fight this- take action today!

Debra Dihoff, MA

Executive Director

NAMI North Carolina

What is the Issue?

North Carolina has an exemption from requiring people on medicaid to go through an authorization process to get the drugs that they need to treat their mental illness.  This may change!!  The state is trying to limit overall drug expenditures.  This may mean just saying no to a drug that works for you or your loved one.  It may mean failing first on a cheaper drug before you can get back on a drug that has worked.  It is hard on the doctors who must complete much more elaborate paperwork, it is hard on those living with a mental illness, and it is hard on their families. 

We need to work to continue protecting these vital medications, we need to continue the exemption.  Do not balance the budget on the backs of those with mental illness.

Important Points:

1. Drug expenses in NC have actually decreased by $153M from 2009 to 2012 due in part to increased rebates
2. We must preserve the Doctor-Patient decision making authority; drugs work differently on everybody.  Don't limit the number of products available, as you may not have access to the one that works for you. 
3. Studies show that this idea for balancing the budget doesn't work well.  In Maine, they found a 6% greater likelihood of a gap in medication occurring from prior authorization, and an 18% greater risk of a person going 30 days or more without medication when they made this policy change.
4. A study in Alabama with medicaid claims data around ER visits found that admissions related to behavioral health could have been avoided if people were able to consistently take their medications.  Consequently, they showed an increase in hospital costs of over $264M
5. There are better ways to be smart about money but not endanger those with mental illness. There is the A+ Kids program, and a similar one for adults which works on safety monitoring of antipsychotics prescriptions that may not be consistent with FDA requirements.  We need more focus on these educational programs to help doctors get the dosage and match of medication  right.   Much money can be saved with this approach without imposing prior authorization requirements.

In short- this approach will balance the budget at the expense of people with mental illness, making it harder to get well and stay well.  We know from other states who have gone this way that it may in the short run save money, but it will end up costing more when adverse events occur:  people landing in the emergency room, in hospital beds, even in homeless shelters, jails, and prisons.  It costs our society much, much more than keeping people on the medications that keep them well.