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For many mental health consumers, access to the range of the newest and most effective medications is crucial for successful treatment and recovery. New advances in medications, combined with other therapies, allow people to lead healthy and productive lives in their communities. Research shows that newer medications are more effective, have fewer side effects, and save money over time. 

In response to tighter budgets, some states are imposing dangerous restrictions on access to the medications. While Mental Health America understands that states are facing major budget shortfalls, it is essential that people with mental health disorders have full access to the most effective treatments available.

Most States Have Exempted Mental Health Medications from Restrictions

  • The Kaiser Commission on Medicaid and the Uninsured recommends that "all psychotherapeutic, anti-viral and anti-convulsive medications" be exempt from restrictions.
  • 29 states have laws or regulations that exempt mental health medications from restrictions in their Medicaid program, including Indiana, North Carolina, Kansas, Missouri and Virginia. Unfortunately, there are increasing threats to those exemptions in states like South Carolina, Tennessee and Florida.
  • Most states, including California, Texas, and Michigan, approve well over 90% of prior authorization requests. This demonstrates that most physicians have medically necessary reasons for prescribing certain medications.

Each Mental Health Medication is Unique

  • Unlike many medications that treat other illnesses, medications that treat mental illness cannot be used interchangeably because each medication has a different mechanism of action and affects each person's brain in a different way.
  • Clinicians work with their patients (or consumers work with their doctors) to determine the best choice of medication that takes into account the individual's health history, physical health issues, co-occurring physical health conditions, range of symptoms, race and ethnicity, and treatment goals. It is impossible for policies that universally restrict access to the full range of therapeutic alternatives to account for such individuality.
  • The wrong medicine may not only fail to work, but also can have intolerable side effects, such as significant weight gain, muscle spasms, blurred vision, severe insomnia or fatigue, or kidney malfunction.
  • Changing psychiatric medications is very difficult. It can take up to 6-12 weeks to determine if a medication works, and each failed trial results in suffering and possible worsening of a person's condition.

Restricting Access to Mental Health Medications Costs More

  • No real cost savings will result from Medicaid cuts that limit medication choice and services for people with mental illness. Without the right medication, people with mental illness may stop taking medication or treatment, and increase the likelihood of a serious episode, resulting in emergency room visits, in-patient hospitalization, and crisis services.
  • While one day in an inpatient psychiatric facility costs $556, the most expensive medication to treat mental illness costs less than $28 a day. Access to the right medications can reduce wasteful spending.
  • Patients who switch SSRIs are in treatment 50% longer and cost approximately 50% more to treat in more costly treatment settings.
  • Current state prescription drug utilization management strategies are associated with significant adverse clinical consequences for this population. Medication disruptions or switches that are not clinically indicated have been shown in this and other studies to be associated with significant adverse effects for psychiatric patients.
  • Imposing Medicaid co-payments (even nominal amounts such as $2), leads to reduction of appropriate health care utilization, making medications last longer by not taking prescribed amounts, and causing serious financial hardship.

Mental Health Treatment Works

  • A 2003 study from the National Bureau of Economic Research Reporter found that newer medications generally increase longevity, decrease activity limitations, and reduce total medical expenditures.
  • According to the National Institute of Mental Health, success rates of treatment for disorders such as schizophrenia (60%), depression (70-80%) and panic disorder (70-90%) surpass those of other medical conditions (heart disease, for example, has a treatment success rate of 45-50%).

States Must Improve Best Practices in Mental Health Services

  • Rather than limit access to medications, states needs to focus on practices to improve patient health and contain costs such as:
  • Provider peer education initiatives which improve clinical practice
  • Closer review and retrospective intervention with cases of polypharmacy or other inappropriate prescribing
  • Case management of chronic illness to improve coordination of all medical and mental health care, including medications.
  • Closer data review to identify fraud, deviation from clinical best practice, outlier prescribers, and clinicians that are "under"dosing.