Bazelon Center for Mental Health Law
Calls on States
to Protect Consumer Rights
Medicaid Budgets Should Not be Balanced
Through "Backdoor" Limits on Access to
Mental Health Services
or Prescription Drugs
States must not be allowed, in the name or cause of balancing
their budgets, to restrict access to medications or services that consumers
want and need. Controlling costs may be an important objective for a state
or public agency, but it must be balanced by legal protections for covered
individuals so that consumers have appropriate choices and are not denied
medication or services in order to limit public outlays.
Recently, states have begun to impose various restrictions
on Medicaid phar-macy programs. Those restrictions masquerade as simple
administrative procedures, but they are in fact so burdensome and time-consuming
for consumers, doctors and pharmacists that they reduce access and undermine
quality of care. For example, states increasingly create preferred drug
lists and require prior authorization for non-listed drugs. Prior authorization
is a sensible approach for drugs with questionable efficacy, but when
decisions to exclude medications are based on economic rather than clinical
factors, the prior authorization process becomes a barrier to appropriate
services. People with “serious” mental illness commonly are
prescribed medications for extended periods. Impeding access to the medications
these individuals prefer—often newer generation drugs with fewer
side effects and greater efficacy—creates delays in services, reduces
the likelihood that the individual will remain in treatment and can have
significant long-term implications for quality of life.
On June 28, PhRMA filed suit to prevent Michigan from
implementing prior authorization restrictions on pharmaceuticals based
on economic factors. We agree with PhRMA that states’ actions to
limit access to medications not for clinical reasons, but as a strategy
to leverage cost reductions in their Medicaid pharmacy programs may ultimately
achieve no real savings and, more impor-tant, create significant risks
for individuals with mental disabilities.
Medicaid pharmacy programs should not subjugate their
therapeutic objectives to cost-cutting determinations that do not serve
consumers and that deliver bottom-line savings more imagined than real.
-30-
The Bazelon Center for Mental Health Law is the leading
national legal-advocacy organization representing people with mental illness
or mental retardation. Through precedent-setting litigation and in the
public-policy arena, the center works to define and uphold the rights
of adults and children who rely on public services and ensure them equal
access to health and mental health care, education, housing and employment.
The nonprofit organization is supported primarily by private foundations
and individuals.
|
