Postion Statement 32: Access to Medications
Statement of Position
Mental Health America envisions a society in which all people have
access to a full array of high quality, community-based, culturally competent,
integrated mental health services, regardless of ability to pay. For many
mental health consumers, access to the range of the newest and most effective
medications is a crucial component of successful treatment and recovery. New
advances in medications, and their combination with other services and supports,
allow people with mental health disorders to lead healthy and productive lives
in their communities.
Mental Health America opposes policies that restrict access to medically
necessary medications. Such policies, which include Preferred Drug Lists
with prior authorization requirements, restrictive formularies, fail first
requirements, monthly prescription limits, and tiered co-payment structures,
fail to achieve
their intended purpose of reducing overall healthcare costs, prolong human
suffering and reduce the potential for an individual with mental illness to
achieve full
recovery. Moreover, restrictive policies fail to acknowledge that physicians
and consumers should make treatment decisions, to recognize the unique and
non-interchangeable nature of psychotropic medications, and to acknowledge
that lack of access to
medications has both human and fiscal consequences.
As alternatives to these restrictive policies, Mental Health America supports state efforts to implement utilization management strategies the promote and improve the quality of patient care for individuals with mental health disorders while seeking containment and reduction of pharmaceutical costs to state Medicaid and other public health programs. Such strategies –which are premised on open access to all medications approved for the treatment of mental illnesses –include closer scrutiny of utilization data to manage cases of polypharmacy, fraud and abuse; provider education initiatives targeted at high volume prescribers; disease management programs; and algorithms and other practice standards that promote appropriate prescribing based on clinical data and evidence-based practice.
Recognizing that many states have already implemented a Preferred Drug List, Mental Health America supports the exemption of all medications used to treat mental illnesses from prior authorization requirements. Such an exemption should address all classes and not include limits based on diagnosis. Moreover, states that have implemented Preferred Drug Lists and other restrictive policies should ensure that the following consumer protection policies exist and are enforced:
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No "fail first" requirements;
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Prescribers should have the option to designate “Dispense As Written”to prevent automatic switching at the pharmacy point-of-sale;
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A “grandfathering”policy should exist to ensure that patients who are successfully being treated on a non-preferred medication are not forced to switch.
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Preferred drug lists should be developed based on clinical evidence and scientific consensus taking into account efficacy, safety, and cost;
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Utilization management strategies should be developed by a Pharmacy & Therapeutics Committee that includes practicing physicians in the field of mental health treatment;
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The process for developing state utilization management strategies should include meaningful involvement from consumers and adequate opportunity for public input;
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Prior authorization should be timely and efficient so as not to delay access to medication, nor to deter the prescriber from ordering medications that will have optimal benefits;
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Appeals and grievance procedures must be clearly disseminated to beneficiaries subject to restrictions and must be both accessible and timely;
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Management of consumer information during the prior authorization process should be consistent with Mental Health America’s Standards for Responsible Management of Consumer Information.
For further background information and detailed examples of alternative utilization management strategies, refer to Mental Health America’s Issue Brief Series: Access to Medications for Public Health Programs, which includes the following components:
- The Case for Open Access to Medications
- State Policies that Restrict Access to Medications
- Essential Consumer Protections for Medication Policy
- Promoting Appropriate Use of Medications
Effective Period The Mental Health America Board of Directors approved
this policy on March 7, 2004. It will remain in effect
for five (5) years and is reviewed as required by the Mental Health America Public Policy Committee. Expiration: December 31, 2009 |
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