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Testimony by NAMI PA 2008
Pharmacy and Therapeutics Committee Meeting
August 19, 2008
Jyoti R. Shah, M.D. DFAPA
President, National Alliance on Mental Illness Pennsylvania
James W. Jordan, Jr.
Executive Director
National Alliance on Mental Illness Pennsylvania
Subject: Open Access to Psychotropic Medications
To: Members of the Pharmacy and Therapeutics Committee
On behalf of the National Alliance on Mental Illness Pennsylvania
we are writing to urge you to support open access to ALL Psychotropic
medications. We believe that restrictive formularies, dosage limits,
quantity limits and fail first with cheaper medications including prior
authorization process are very risky factors for the mental health of
our consumers as it delays the quality care, increases the risks of
negative outcomes and actually negatively impacts the over all health
care cost. We believe that open access to all Psychotropic medications
is essential in a recovery model for persons with mental illness.
We are requesting your support that will allow consumers
and their physicians to make decisions that are specific, individualized
to the mental health needs of that consumer. Decisions regarding specific
medications prescribed for persons with severe mental illness should
be based on the clinical judgments of the clinicians, not on economic
factors. NAMI PA strongly opposes measures that limit treatment with
psychotropic medications as newest, most effective medications such
as atypical antipsychotics and newer antidepressants.
Rising pharmacy costs must be understood as part of the larger picture:
dramatic reductions in long-term hospitalizations and criminalization
result from access to effective medication, comprehensive outpatient
treatment and timely short term inpatient treatment. We need to ensure
that people with mental illnesses have adequate medications so fewer
people end up being hospitalized longer than necessary or inappropriately
incarcerated.
We would like to make following points for considerations:
• Open access results in best treatment outcome. Open access to
the full range of medications for people with mental illness is critically
important for achieving the best possible treatment outcome for patients
as quickly as possible, which leads to the most cost-effective outcome.
• Psychotropic medications are not interchangeable. Unlike many
medications that treat other illnesses, medications that treat mental
illness can’t be used interchangeably. The side effects of these
medications can be extremely serious, and vary with each patient. The
worse the side effects, the less likely a patient will be able to stay
on treatment
• Patient prescription adherence decrease. Because patients are
less likely to adhere to treatment on medications that are not best
for them, they are more likely to suffer a serious episode
• Higher costs associated with episodic relapse. Each episode
results in immediate, short-term additional costs to the Medicaid budget
through emergency department treatment, inpatient hospitalization and
crisis services.
• Denial of medications has higher cost systems ripple effect.
Both shorter and longer-term costs to the state budget outside Medicaid
will also increase if patients are denied needed medications, including
increased incarceration and increased homelessness.
• Medications are treatment and cost effective. Medications are
both effective (they result in good treatment outcomes for people with
mental illness) and cost effective (they save money over alternative
forms of care for people with mental illness). Unlike the rest of healthcare,
medications comprise only 3% of costs for mental illnesses—and
some experts contend that they may be responsible for more than 50%
of positive treatment outcomes. (M Graham, “Restrictive Formularies,
“National Mental Health Association, Department of Healthcare
Reform)
• Treatment Works. According to the National Institutes of Health
(NIH), over 80 percent of people with mental illness can get better
with treatment. The U.S. Surgeon General said that people with mental
illness who receive appropriate treatment can experience a significant
reduction in symptoms and can live, learn and work in the family and
in the community.
NAMI PA encourages the use of clinically tested medication algorithms
to ensure the utilization of evidence-based medication practices. The
Texas Medication Algorithm Project (TMAP) has produced treatment algorithms
(including prescription drug therapy) for three serious mental illnesses
– schizophrenia, major depressive disorder and bipolar disease.
The paradigm has been adopted in other states including Pennsylvania.
NAMI PA is supportive of the continued development and evaluation of
the efficacy of this program.
NAMI Pennsylvania supports polypharmacy education programs
as an alternative to restrictive cost containment programs.
NAMI PA supports development of explicit protocols with
rigorous follow-up assessments.
Thank you for the opportunity to share our comments on
this important issue.
