Access to Mental Health Medications

The Governor’s budget assumes savings of $35 million through prior authorization of SSRI anti-depressants. The proposal would require prior authorization for medications other than generic Prozac rather than offering a full array of anti depressants. Additionally, the Governor and others are exploring the use of a preferred drug list (PDL) as a way to reduce State spending.

Talking points for exempting mental health medications from prior authorization or PDLs.

Keeping open access to mental health medications saves money and lives.

• For every $1 increase in spending on newer prescription medicines, nearly $4 is saved in non-drug medical spending such as hospitalizations and doctor visits (Source: Columbia Univ.).
• A study of Medicaid costs for treating schizophrenia found that an increased budget for medication resulted in a decrease in hospital costs and overall costs per patient.

There can be devastating effects if mental health medicines are altered or denied, even if only for a few weeks while other medicines are tried.

Limiting access to medications for people with mental illness is comparable to limiting wheelchairs for people with physical disabilities.

The Kaiser Commission on Medicaid and the Uninsured recommends exempting psychotropic medications from prior authorization under Medicaid. About a dozen states that have prior authorization for drugs or preferred drug lists have come to the same conclusion.

Prozac, or the generic equivalent, is not always the most appropriate medication to be prescribed by a psychiatrist. People drop out of mental health treatment (up to 25%) because of negative experiences with Prozac, or the generic equivalent. According to research these medications should not be given to:

• anyone with low weight (especially seniors) or an eating disorder as it causes weight loss.
• anyone who is experiencing agitation as it may make it worse.
• anyone who has bi-polar disorder.
• nursing mothers.
• anyone who abuses alcohol as it has strong effects on the liver.
• someone who is also taking other medications as it interferes with the effectiveness of other prescriptions.

Missouri has implemented a utilization review program by Dr. Richard C. Surles who presented to the DHFS last year and could be retained to assist with its implementation here in Wisconsin. This project costs approximately $250,000 per year and is being paid for by pharmaceutical companies. Other states to look to for utilization reviews models are Texas, California and Iowa.