Tell the Administration that Denying Access to Essential Medications for People With Disabilities Does Not Increase Health Care Access! Here's How! By Julie Reiskin
The mixed messages given by our government and society in general to people who have mental illness is enough to drive anyone crazy. (pun intended). All they hear is how important it is to take their medications. While some have not been helped or choose not to take medications, thousands have been helped by medications. Psychiatric medications can even be forced by the courts in extreme situations.
People that do rely on medications and have achieved stability have often struggled mightily to get there. It can take years to come up with the right combination of medications. A good doctor will continually monitor medications and slowly reduce some medications once stability has been attained. People who have successfully tapered off of psychiatric medications do so over a long time, meaning a several months or even a year or longer. It is imperative that the psychiatrist maintain complete control over this process influenced ONLY by how the individual is feeling. People are able to report symptoms and can almost always tell if the reduction is too fast or not.
When the Part D Medicare Drug program was implemented in 2006, certain categories and classes of drugs were protected. This means that drugs for some conditions including mental illness, cancer, epilepsy, and AIDS, that substantially all drugs must be offered by the various plans. While some people react with extreme sensitivity to any medication change or difference, there is evidence that with certain diseases and certain categories of medication individuals with the same condition react differently to the same medication. This is why certain medications were protected by the Part D law: Medications for mental illness, cancer, HIV and epilepsy were specifically promised to be made available with minimal restrictions. Medications for other diseases where there is less at stake and where there are more options for medication treatment were not protected. Now the Obama administration is trying to break the promise to SOME but not all of the Medicare patients protected by the Part D promise. Interestingly the promise is only being broken for mental health medications (and those for transplants because those medications have been made generic).
The CMS proposal will allow plans to immediately limit drugs other than anti psychotics in 2015 and but will allow plans to limit anti psychotics in 2016. Most of the savings calculated are from the ability to limit anti psychotic coverage. To keep people on medication a doctor would need to state that the patient would likely be dead, hospitalized or be incapacitated in seven days. Changing psychiatric medications will often but not always cause these problems but rarely in only 7 days. It is easy for some researcher to say there is no real difference between medications. Until that individual suffers from akathisia or has his or her life fall apart after attaining hard fought stability, that proclamation is too easy to make. Some people can transition to cheaper medications, but others cannot. Is it really worth the risk, given that once you destabilize someone you may never be able to regain the original stability? Anyone who says this is no big deal should be willing to personally take that gamble with his or her own life.
Often people with serious mental illness have to take several medications to achieve stability. The medications work in combination and any change could upset the entire apple cart. Anti psychotics are the most expensive. New medications continue to be developed. There is good reason for this development—current medications do not address all forms of psychosis and have devastating side effects. People who take anti psychotic medications often end up with significant weight gain, diabetes, and movement disorders. Any newer options should be continued and should not be limited. The National Institute of Mental Health is clear that no one can tell beforehand how a person will respond. Sometimes a person needs to try several medications before finding the right one. Doctors and patients can work together to find the best medication or medication combination, and dose.
The idea that some insurance company will receive government blessings to dictate step therapy or set any limit on the types of medications that can be prescribed to people with mental illness is scary. Will they force people to “try” a medication that may have caused serious and painful side effects in the past? Because of the sorry state of mental health care in this country not all past experiences will be documented or accessible. Even without a history of problems with a specific drug, will they disrupt the stability that has been achieved because the medications are not part of a formulary?
The government will likely try to reassure people by stating that these companies have exception processes in place. They do and for most people without cognitive challenges and with doctors who are not over-extended the exceptions process usually works. People with mental illness often struggle more than most to manage the various bureaucracies. If the only way to keep or get the appropriate medications is to go through some exception process, the result will be people who have been stabilized destabilizing. If the already over-taxed psychiatrists have to start playing “mother may I” with the insurance companies, the patients will suffer. This is not because psychiatrists are bad but due to the dysfunctional system those that treat people in the publicly funded systems are way past being overwhelmed. Moreover, each step can add days to a process when the patient may need medication now.
A Boston Globe Article quoted the administration as accusing mental health professionals of prescribing drugs because of their own financial interests. Moreover, if the administration thinks the mental health professionals are so corrupt, why are they encouraging people to use mental health services? The article explains that reports show that the prescription drug plans spend more on the protected categories and classes than they spend on other drugs. This should not be a shock. These medications are expensive. If there is no need for protections, why not end protection for all disease groups? Why should cancer or epilepsy deserve more protection than mental illness? People with cancer or epilepsy are rarely shamed into taking medications or court ordered to do so. Or is the issue that people with cancer and epilepsy have more public sympathy or better lobbyists? Why delay anti-psychotic access limitations for one year if there is really no harm? If the real issue is concern about psychiatrists with ulterior motive then the administration should do something to increase access to psychiatrists particularly for second opinions for people in the publicly funded systems. According to The Office of Inspector General the conflict of interest problem is more about how the program is managed than anything else. Giving those causing the problems more power over a vulnerable population makes no sense and will not solve the problem.
Just last year, a SAMHSA publication promises that the Affordable Care Act would make access to medications easier! After years of preaching about the need for health care for everyone, how can the administration in good faith now take away this essential protection for one of the most vulnerable groups in the country? If you are outraged out this attempt to save money on the backs of our most vulnerable please submit your comments before March 7th. Go here for the action alert from Arc US and follow their directions. The definition of insanity is doing the same thing and expecting different results. When will we learn that NOT providing care is a bad idea?