Prescriber prevails tagged posts

David Precise 
Executive Director of NAMI Louisiana

Jumping Over a Dollar to Pick Up a Nickel
How mental health policies, including the new Medicare Part D proposed rule, sacrifice patient outcomes and long-term cost control for short-term savings

There is an expression I use—jumping over a dollar to pick up a nickel—that describes ignoring one reward in pursuit of another, smaller prize. Blinded by the appeal of the shiny nickel, we ignore the dollar right beneath our feet. Too often, our nation’s mental health policies are driven by such short-sighted mentality; and too frequently, people with mental health disorders suffer as a result.

When the Centers for Medicare and Medicaid Services (CMS) recently announced a Medicare Part D proposed rule, one which would restrict beneficiaries’ access to important antidepressants and antipsychotics, I was disappointed to see yet another example of this reckless mindset. For while restricting formularies is often proposed as a way to control health care costs, we know that denying patients’ access to the full category of drugs often leads to worsening conditions and increased health costs down the road.

That’s because every human being’s brain is different and responds to treatment in different ways. If there are 20 different drugs for schizophrenia and the formulary is cut to just the four cheapest, we put individuals at great risk, and society incurs the associated health costs of untreated and uncontrolled mental illness.

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Ben Nevers
State Senator Louisiana

For the past three weeks we’ve devoted this blog to raising awareness around a proposed regulation by the CMS to restrict access to mental health care. But did you know that individual states have fail first policies as well, through the implementation of their Medicaid programs? Read today’s post to learn if your state is on the list.

Louisiana is a National Leader with their “Prescriber Prevails” Medicaid Policy
Keeps access to medication in the hands of physicians and patients

There are many reasons why people do not receive adequate mental health treatment, each of those reasons is as unique and as highly personalized as the individuals themselves. Yet, nearly all stem from the fundamental problem of access. Access to timely, appropriate, affordable mental health care is too often limited and restricted as a result of the following:

• a shortage of providers or inpatient beds in a given community
• insurer restrictions on what, when and how providers can prescribe medication and treatment
• cost barriers that put mental health care financially out of reach

When such barriers obstruct access to care, more people are at risk for serious, disabling mental illness; and in those cases, society bears the related costs. For that reason, I believe we must work together to address these barriers and expand access to mental health services. The cost of not doing so is enormous.

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Senator David Carlucci
Chair, Committee on Mental Health and Developmental Disabilities
New York State Senate

On this blog a few days ago, Andrew Sperling of the National Alliance on Mental Illness raised questions about access to mental health treatments under the Affordable Care Act (ACA); and he voiced concerns about people being able to receive the specific mental health drugs they require once the health reform law is implemented.

As Mr. Sperling pointed out, restricting access to a full class of drugs and limiting prescribers’ option to one drug per class—which health plans can opt to do under ACA—can be short-sighted from an economics standpoint and disastrous from a health perspective. Without access to clinically appropriate medication, individuals with mental illness have higher rates of emergency room visits, hospitalization and other health services.

As Chair of the New York State (NYS) Senate Committee on Mental Health and Developmental Disabilities, I understand that in order to manage the health of people living with serious mental illness, patients need guaranteed access to the full range of drugs and services that are most likely to improve their health. Even more important, I recognize that no one understands a patient’s needs better than his or her healthcare provider; and it’s presumptuous—if not irresponsible—to remove decision-making authority from that provider.

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