JEFFERSON CITY — Longstanding law mandates that people with severe mental illness should face “no restrictions to access” to treatment. Now, lawmakers want to tweak that.
In other states, similar programs that limit access to medications have led to fewer people seeking antipsychotic drugs, studies show. But some Missouri lawmakers argue that the move would save the state money in administering its Medicaid program during a budget bind.
“For us to do nothing in changing how pharmacy is handled in Medicaid is, I think, somewhat irresponsible,” said Rep. David Wood, R-Versailles, who introduced the legislation in the House.
If the legislation is passed — no guarantee with the session winding down to its final days — it would create a preferred drug list for medications that treat mental illness. Doctors would have to prescribe the drugs on that list first.
Patients on Medicaid, which the state helps* pay for, would be able to access drugs that aren’t on the list by having doctors request permission, called “prior authorization.”
Non-antipsychotic drugs are already on a preferred drug list for Medicaid patients in Missouri, Wood said.
Advocates said antipsychotic drugs and drugs that treat heart conditions or injuries shouldn’t be treated the same way. Finding the right medication for an individual with a mental illness might take several attempts, and having to request a waiver to access each drug might interfere with that process, they said.
A records custodian for the Missouri Department of Mental Health said the state doesn’t keep track of how many medications patients try before finding one that works for them, making quantifying the scope of the issue difficult.
If the bill becomes law with that language in it, Wood is concerned that the preferred drug list would be moot.
“It basically wipes it out,” he said. “It makes it totally useless.”
Wood said there will be a push to take the “no restrictions to access” language out of the bill in the session’s final days.
Even with that language included in the legislation, the best option for people with mental illness would be no preferred drug list, said Jacqueline Hudson, the advocacy director for NAMI’s St. Louis branch.
No preferred list has been created yet, Wood said. But the drugs that eventually land on it would, presumably, be among the cheaper options available.
In other states, there’s evidence that a prior authorization led to fewer people seeking antipsychotic drugs.
A 2008 study in Maine found that the number of people who sought antipsychotic drugs after it instituted prior authorization dropped by about 30 percent.
Also, in 11 states with a prior authorization requirement for Medicaid, the use of antipsychotic drugs rose by 14 percent between 1999 and 2008. In the 19 states without it, use rose by 19 percent, according to a 2011 study.
Wood said these studies were one “perspective.”
“We’re not denying (people with mental illness) anything,” he said of the proposed policy change.
Sater agreed with Wood, saying he didn’t think the same results would happen in Missouri.
“Our program is different from other states,” he said. “We have a very smooth transition in the prior authorization. It usually just takes a matter of seconds to have it approved. It’s very seamless.”
The decision on whether to approve a non-preferred medication happens “instantly” if a prescriber has all the correct information needed for a prior authorization and submits one electronically or requests one on the phone, said Rebecca Woelfel, a Missouri Department of Social Services spokeswoman.
Otherwise, she said, approval or disapproval of the non-preferred drug is required within 24 hours.
For instance, access to radiology treatment can take a few days, but admission for inpatient care can “take up to 24 hours,” she said.
“A timeline” for treatment, she wrote in an email, “depends largely on each individual and what, exactly, he or she needs.”
NAMI’s Hudson agreed.
“We don’t have the luxury of time on our side when we treat people with mental illness,” she said.
* This article has been updated to be clearer about which entities pay for Medicaid. It is both the state of Missouri and the federal government.