AMA Reaffirms Commitment To Parity For MH Care

AMA reaffirmed its support for parity in treatment coverage for mental illness and substance use disorders at last month's meeting of the AMA House of Delegates in Las Vegas.

Moreover, the organization will be working with state and specialty societies to prepare a report that includes a summary and analysis of existing parity laws and a review of the research on the impact of parity on access, quality, and the cost of health care at the state and federal levels.

The AMA's commitment is the result of a resolution brought to the House of Delegates by APA, the American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Psychiatry and the Law, and the American Academy of Pediatrics. The resolution was approved with support from physicians of all specialties.

John McIntyre, M.D., chair of the Section Council on Psychiatry of the AMA House of Delegates, said the house has demonstrated over the years “very solid support” for parity. “Medicine as a whole is behind us completely,” he said. “Parity is not a hard sell for psychiatry any longer. There is absolutely no discernible opposition to it.”

David Fassler, M.D., AACAP's delegate to the AMA house and vice chair of the psychiatry section council, said the AMA's commitment will be a“ valuable asset” in advocacy efforts.

“By this action, the AMA has reaffirmed its long-standing commitment to parity,” Fassler told Psychiatric News. “They've also agreed to work with us to evaluate the legislative history of parity and to develop a comprehensive report analyzing the available data on the actual experience with parity at both the state and federal levels.”

In reference committee hearings prior to the house vote, Fassler said that despite parity legislation being passed in a number of states, the majority of Americans still lack access to comprehensive, nondiscriminatory coverage for treatment of mental illness and substance use disorders.

“Some states still allow higher deductibles or differential annual and lifetime caps,” he said at the reference committee hearing.“ Many states exclude coverage for substance use disorders. At the federal level, we've been unable to pass the Paul Wellstone Mental Health Equitable Treatment Act despite the efforts and support of the AMA. And the Medicare program still contains a discriminatory 50 percent copay for the treatment of mental illnesses, an anachronistic and discriminatory provision that would never be tolerated if applied to patients with any other medical disorder.”

Representatives to the AMA house from psychiatry were also instrumental in revising a report by the AMA board on physician notification of a pharmacist's refusal to fill a prescription. The original wording in that report stated that when a pharmacist refuses to fill a prescription—for moral, religious, or other personal reasons—he or she must inform the patient of those reasons. But APA Vice President and alternate AMA delegate Nada Stotland, M.D., M.P.H., told AMA delegates that the wording invites pharmacists to offer unsolicited moral lectures to patients.

“This proposal is well intentioned,” Stotland said during reference committee hearings on the report. “However, this issue has been brought to the forefront by pharmacists' refusals to dispense Plan B, the postcoital oral contraceptive and, in some cases, all contraceptives. There are numerous reports of pharmacists' giving religious and medically unfounded lectures to patients who bring these prescriptions to be filled.”

Stotland said the resolution was “not responsive to the intent of the original resolution, which was to require that pharmacists who refuse to dispense prescribed medication inform the prescribing physician, it intrudes on the doctor-patient relationship, and the proposed wording invites pharmacists to give unsolicited unscientific and religious lectures to unsuspecting and vulnerable patients in need of a time-sensitive treatment.”

In response to Stotland's testimony, and that of supporting physicians, portions of the report recommendations calling for pharmacists to explain their reasons for not filling the prescription were removed. As approved by the house, the report now reaffirms the AMA policy in support of legislation requiring individual pharmacists or pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy without interference.

“In the event that an individual pharmacist or pharmacy chain refers a patient to an alternative dispensing source, the individual pharmacist or the pharmacy chain should return the prescription to the patient and notify the prescribing physician of the referral,” the report states.

Soft Drink Tax Debated

Last month's interim meeting of the AMA took place as the federal government was issuing a final rule on Medicare's physician reimbursement for 2007 that will cut average overall physician payments by more than 10 percent (see page 1).

At the opening of the meeting, Health and Human Services Secretary Mike Leavitt told physicians of the need to cut ever-spiraling costs and of the government's commitment to quality reporting by physicians in the form of its“ pay-for-performance” (P4P) program. Much of the discussion at the meeting focused on physicians' growing anger over the government's Medicare payment formula and disenchantment with P4P (see box on page 6.

But the interim meeting, which has come to be devoted largely to the AMA's public health and advocacy agenda, also saw spirited debate about a proposal to recommend that sweetened soft drinks be taxed and the revenue be used to combat the nation's epidemic of obesity.

Proponents of the measure, including AMA board member and president-electron Davis, M.D., said sugar-laden soft drinks contribute prominently to obesity and are a significant public health problem. A small sales tax on sweetened soft drinks would act as a “user's fee” and could significantly reduce consumption, Davis and other supporters said. The tax revenue would be used to fund public health programs aimed at obesity.

The tax was opposed by representatives of soft-drink manufacturers who testified at the meeting. But it also was opposed by physicians who disagreed with the strategy of taxing a single product and who pointed out that funds, such as those from tobacco-company settlements, earmarked for public health purposes have not been used for their intended purposes.

The tax proposal was defeated, but delegates overwhelmingly approved a statement calling on the AMA to “assume a leadership role in collaborating with other interested organizations, including national medical specialty societies, the American Public Health Association, the Center for Science in the Public Interest, and the AMA Alliance, to discuss ways to finance a comprehensive national program for the study, prevention, and treatment of obesity, as well as public health and medical programs that serve vulnerable populations.”

The resolution also encourages “state medical societies to collaborate with interested state and local organizations to discuss ways to finance a comprehensive program for the study, prevention, and treatment of obesity, as well as public health and medical programs that serve vulnerable populations.”

Other Actions

AMA delegates also approved the following:

More information on the AMA's interim meeting can be accessed at<www.ama-assn.org/ama/pub/category/16552.html>.▪