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Testimony
James W. Jordan, Jr.
Executive Director
National Alliance for the Mentally Ill
Pennsylvania Chapter
(NAMI PA)
Senate Aging & Youth Committee
Public Hearing on House Bill 888
September 29, 2003
Senator Orie and distinguished members of the Senate Aging and Youth Committee,
thank you for inviting the National Alliance for the Mentally Ill, Pennsylvania
Chapter (NAMI PA) to testify on the merits of House Bill 888.
NAMI PA is the largest statewide non-profit organization that is dedicated
to helping mental health consumers and their families rebuild their lives
and conquer the challenges posed by severe and persistent mental illness.
Our purpose is to help all people who are affected by mental illnesses,
including families, friends, consumers, neighbors and coworkers. We strive
to educate the public about the true nature of mental illness to combat
the stigma and discrimination often faced by persons with mental illness.
We have 60 affiliates across the Commonwealth who provide support, education
and advocacy within their communities.
To that end, I am here today to discuss the importance of the PACE program
for older persons with mental illness and the proposed efforts to preserve
its future. We appreciate that states in general are under tremendous
financial pressure and are looking at ways to reduce expenditures within
programs. However, as policymakers, it is important to weigh decisions
that are based on short-term financial gains against the long-term financial
consequences. We oppose efforts that attempt to reduce expenditures by
limiting access to the most effective medications through the use of higher
copays, preferred drug lists, prior authorization, therapeutic substitution,
and fail-first policies.
A simple analogy is car maintenance. You can save some upfront money by
not changing the oil in your car, your expenditures for oil go down; but
ultimately, the cost of not replacing the oil will far outweigh the upfront
cost of the oil.
Medication is similar. You can save upfront costs by limiting access to
prescription medications, but ultimately you will experience additional
costs due to untreated health conditions and ineffectively treated mental
illness. This is especially true with mental illness. Prescription medications
help patients manage their health conditions, prevent the need for nursing
home care and prevent hospitalization.
A 1991 study published in The New England Journal of Medicine found that
when New Hampshire restricted the number of prescriptions reimbursed by
Medicaid, drug utilization fell by 35 percent. However, nursing home admissions
rose 60 percent and overall health care expenditures increased. When the
restrictions were lifted, nursing-home admissions decreased.
NAMI PA and other mental health advocates strongly support the existing
exemption for mental health drugs that is contained in House Bill 888.
The mental health exemption is there for a reason. It’s because
there is no “one size fits all” approach to treating mental
illness. Many patients respond better to some medications while others
do not. Many patients having the same symptoms will require completely
different drugs in order to control and manage their disease. Adherence
to medication is very critical for persons with mental illness and it
is critical that they receive the medication that best meets their individual
health care needs. Eliminating the exemption would mean that only people
with schizophrenia will receive open access to drugs. Psychotropic medications
are used to treat a variety of mental illnesses, including bipolar disorder,
depression, anxiety related disorders, catatonia, aggression and other
conditions. Limiting access to anti-psychotic medications does not solve
the problem. There are other psychiatric needs such as mood stabilizers,
anti-depressants, anti anxiety medications and cognitive enhancers. All
are life sustaining medications. Without exemption for these medications
even people with psychosis will suffer non-psychotic illnesses such as
mood disorders, disorders of cognition and anxiety disorders. Pervasive
developmental disorders are all serious illnesses that can result in death
or disability. Persons with non-psychotic mental illnesses are just as
likely to suffer morbidity and mortality as persons with psychosis and
should have equal access to medication.
Open access to medications for persons with mental illness is important
not only for patients with schizophrenia, but other mental illnesses,
such as depression, which is a prevalent condition in the elderly. Based
on data contained in the 2002 PACE report, the majority of persons with
mental illness who receive PACE and PACENET benefits are receiving treatment
for depression.
Despite what many believe, depression is not a natural part of aging,
and it is a serious problem among the elderly
A study by the National Institutes for Health (NIH) indicated that while
older Americans comprised only 13 percent of the population, they accounted
for 19 percent of all suicide deaths in 1997. The highest rate was for
white men ages 85 and older. According to PACE data, the typical profile
of a person receiving PACE benefits is a 79-year-old woman who lives alone.
Older women are twice as likely as men to become seriously depressed.
Clinical depression is an illness that does not go away by itself. It
needs medical attention just like any other illness. Among other things,
untreated depression can affect the immune system and make the individual
more susceptible to other illnesses.
Thanks to advances in treatment, once diagnosed, 80 percent of clinically
depressed individuals, including older persons, can be effectively treated.
This is where PACE and PACENET make the difference in the lives of older
Pennsylvanians who suffer from depression or other forms of mental illness.
This is where you get a high rate of return on your dollar. But access
to the most appropriate medication is critical in effectively treating
mental illness. We are concerned that any barriers for the elderly population,
including higher copays, prior authorization and therapeutic substitution
will result in less than optimum care.
In my many years in the mental health arena, I have seen the personal
successes that are possible thanks to the newer treatments for mental
illnesses. Sadly, I have also seen the tragedies that can occur when people
are denied access to the treatment that best meets their physical needs.
Again, we appreciate your need to bring financial stability to the PACE
and PACENET programs, but we urge you to look at the overall health care
arena and make a determination about whether this is money well spent
and whether effective medications will ultimately help contain costs in
other areas such as hospital or nursing home admissions.
We believe that that are ways to address costs while maintaining access
to the most appropriate medication. We recommend:
• polypharmacy educations programs that are aimed at reducing the
over prescribing of medications;
• more education on geriatric appropriate dosages; and
• the development of explicit treatment protocols with rigorous
follow-up assessments.
On behalf of the many families and individuals represented in our organization,
we urge you to keep the existing mental health exemption in House Bill
888 and we thank you for listening to our concerns.
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