Open Access To Prescription Medications
Much has been said recently about how cutting prescription drug costs could save $20 to $50 million or more, at the expense of the vulnerable population of those living with severe mental illness. Of course we need to be careful with every dollar spent in this economy, and it makes sense to use science to guide our efforts. But there’s the rub: the studies point out that if you do anything to limit access to medications patients show adverse effects. The last thing we need to do is to save a dollar on prescription medications and spent hundreds on a hospitalization. Stories have been abounding about the current breakdown in care leading to people seeking out care in their local hospitals, and not being able to get treated for sometimes up to eight days such as the recent wait vacant bed reported in Winston Salem. What will happen if we put up more barriers like making it harder to get the prescription drugs that work?
Trying generics for those individuals newly diagnosed is a good first step. More good steps include the bulk purchasing methods and the enhanced use of rebates. But to start with a limited drug list that would affect everyone adds barriers- for both the patient and for the doctors and pharmacists. There is a cost to the bureaucracy of barriers- in human terms and in financial terms.
A recent article in the N & O pretty much said that the drug companies are the reason that the preferred drug list, the method of containing costs, has not happened until this recent round of budget cuts. Well, in truth those people living with mental illnesses and their families also oppose this limitation on getting the right treatment quickly.
So what does the science say to us about adverse effects to limiting access to drugs? A Maine study showed that there is a lack of generic alternatives for second generation antipsychotics, so you can’t save money there. That’s a clear and compelling reason to exempt those with severe mental illnesses from this limitation. Concentrate on areas where generics exist- like gastrointestinal, reflux illnesses, not mental illnesses. A May 2009 study shows that patients with medication access problems had 3.6 times greater likelihood of adverse effects like more ER visits, hospitalizations, homelessness, suicidal behavior, or incarceration. So it’s not really savings, it is cost shifting. More ideas to guide the savings: let’s use the scientific approach of “audit” and “feedback” which is an educational approach to change prescribing behaviors and improve the appropriate use of medications, while guarding against negative side effects. Missouri recently saved millions using this approach systemically.
And let’s talk to those affected by this decision, people who takes medications, not just the prescription drug companies, before making more mistakes in our mental health system in NC.