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Medicaid savings from prior approval? New study erodes rationale for restricting 0access to drugs for mental illness.
Published on Monday, Jul 14, 2008
The governor's motivation was transparent: The goal of the policy was to save Ohio money by closely monitoring the use of high-cost prescriptions, particularly when patents on existing brand-name drugs expired and cheaper generic versions of comparable effectiveness became available.
Estimates of the expected savings made a persuasive case for a prior authorization policy. The Ohio Department of Job and Family Services projected cost reductions amounting to $20 million a year.
A report released last week by the Ohio chapter of the National Alliance on Mental Illness has knocked out the legs from under the policy. For a start, the report observed that state officials have been less than convincing about the anticipated cost savings. The savings dwindled from a projected $47 million in May 2007 to $20 million to $0 by December.
Reviewing the impact of prior authorization in states such as West Virginia, Texas and Maine, the study concluded that implementing the policy in Ohio would raise, rather than lower, Medicaid costs. The estimated additional costs? Between $23.2 million and $38.7 million a year at least.
Doctors and advocates of the mentally ill have strongly opposed prior authorization for mental health drugs for more than financial reasons. They have argued that a prior-approval process would pose serious and unnecessary threats to the health of patients. They have pointed to potential delays in approval that could force patients to go days or weeks without medication, inviting relapses in vulnerable patients and costly emergency care. They see danger also in substituting new medications, interrupting prescription continuity, simply to lower costs.
The study buttressed their objections. Effective medications have vastly improved the life prospects of patients with severe mental illnesses and disorders. The risks to patients themselves and to communities when the mentally ill go untreated or interrupt their medications for whatever reason are only too evident. The costs are counted in the rates of depression and suicides, homelessness and incarceration, job insecurity and troubled relationships.
Granted, controlling Medicaid costs is a top priority. Still, the goal is to lower costs without doing harm. The study has offered reason enough to drop the proposal. It promises to be harmful and costly.
Get the full article here.
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