Unprecedented Florida Medicaid Changes Risks Patients' Health, APA Says

5/26/2005 10:04:00 AM

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To: National Desk, Health Reporter

Contact: APA Communications Office, 703-907-8640 Or press@psych.org; or Jason Young, 703-907-8582, 202-669-5929 (mobile), or Jyoung@psych.org; Web: http://www.psych.org; http://www.healthyminds.org

WASHINGTON, May 26 /U.S. Newswire/ -- In response to Florida's enactment of harmful new Medicaid legislation, the American Psychiatric Association (APA) released the following statement today on behalf of John Bailey, D.O., president of the Florida Psychiatric Society, and APA Medical Director James H. Scully Jr., M.D.:

Today the American Psychiatric Association warned that Florida's enactment of new Medicaid legislation puts people with mental illness at serious risk. The unprecedented and most harmful aspect of the law is a requirement that -- each year -- a patient must first fail on the cheapest mandated medications before the patient is given access to the medication his or her physician believes is optimal, even where the patient has been successfully treated with the physician-chosen medication.

This major health policy setback will help ensure that patients are less likely to get relief from their illness, less likely to experience full remission, and more at risk for adverse outcomes and devastating side effects. Worse, Florida - a bellwether state on Medicaid policy - could ignite a nationwide trend toward public health policies that are regressive and clearly not formulated with patient welfare in mind. Florida's cost-savings expectations will prove illusory at the expense of a vulnerable population.

The American Psychiatric Association believes that the implementation of the new policy will create a statewide mental health emergency. The APA, in collaboration with the National Mental Health Association, the National Alliance for the Mentally Ill, and the National Council of Community Behavioral Health Care, along with each of our state affiliates, will immediately establish an access-to-medications monitoring project to monitor the implementation of these new policies and to provide feedback to relevant stakeholders on actual patient experiences.

The new Medicaid formulary protocols, which could be effective as early as July 1, 2005, represent a major and seriously flawed reversal in public health policy for patients with mental illness. The new policy removed psychiatric medications from exempt status and establishes:

1. A restrictive preferred medication list limiting choice to "the two most cost effective drugs" within the relevant classes, which are by definition classes that are not interchangeable.

2. Establishes a wholly inappropriate annual fail-first step- therapy policy which will force patients to trials on drugs that may not be appropriate for them and to repeat this process annually.

3. Requires yet-to-be-defined prior authorization processes for physicians and patients to negotiate access to needed medications.

The new Florida policy does not make a provision for patients who are presently clinically stabilized or progressing in a defined course of treatment to continue their medications without disruptions. Patients will be forced to endure a series of third-party defined protocols that are not necessarily evidence- based or designed with the patient's best interest in mind.

Patient safeguards, especially for the most vulnerable patient populations, are an important part of establishing needed access to medications. It is critical to provide continuing care and grandfathering protections for those patients who are stabilized on their medication.

Experience has shown that changes like Florida's pose serious harm to individuals who are currently being treated successfully on psychotropic medications and will lead to higher costs across the Medicaid budget in the form of increased hospitalizations, higher rates of emergency usage and all other costs associated with crisis care. The state of Michigan, for example, attempted similar policies only to reverse them subsequently. Florida's projected cost savings are highly unlikely to materialize.

The process to define the details of the new legislation is underway and we note the total absence of any opportunity for interested parties to provide meaningful input to shaping the details of the new policies. We think the projected unveiling of the new policies on June 29, 2005, before the pharmacy and therapeutics committee, with an effective date of July 1, 2005, is wholly inappropriate and in our view inconsistent with the intent of formulary development requirements of Title XIX of the Social Security Act. Moreover, because there is no time to thoughtfully consider the pending policy changes, the changes are fundamentally unfair and punitive toward the affected Medicaid beneficiaries and the practitioners entrusted with their care.

Patients with mental illness are a medically complex and vulnerable population and for whom appropriate medications are essential to their clinical stability in daily functioning. The medication classes used to treat these individuals are highly variable with respect to their effectiveness, tolerability and side effect profiles. Not all drugs work the same for people with the same diagnosis.

Current Florida Medicaid formulary policy incorporates the clinical realties present with by exempting them from narrowly drawn preferred drug lists and inappropriate drug utilization management protocols. Moreover, the cost management approaches presently used in Florida with the current exemption has produced considerable cost savings through the Behavioral Health Collaborative. This responsible management has not jeopardized patient clinical interests or the ability of physicians to optimize first-line treatment choices.

In the best interest of patients and their health, we urge the state of Florida to reconsider the implementation of these policies and to restore current policy, which has demonstrated its clinical appropriateness and responsible cost management.

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About the American Psychiatric Association:

The American Psychiatric Association is a national medical specialty society whose nearly 36,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders. Healthy Minds. Healthy Lives. Care that works to get your mind healthy again so you can lead a healthy life. Visit APA at http://www.psych.org and http://www.healthyminds.org .

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/© 2005 U.S. Newswire 202-347-2770/

 

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