Lessons Learned in Michigan

Thomas Carli, M.D., offered comments to Psychiatric News on the experience in Michigan with implementation of the preferred drug lists as a result of his experience in several roles.

He is director of the University of Michigan Health System Medical Management Center and Disease Management Programs, medical director of the Washtenaw Community Health Organization (an integrated physical and mental health program for Medicaid and the uninsured), and director of managed psychiatric services at the University of Michigan department of psychiatry.

“Michigan, like all other states, had to do something about its rising Medicaid costs. The fastest growing component of Medicaid is pharmacy. The largest category within Medicaid pharmacy is psychotropic medication. Lessons learned [from the Michigan experience] include

• “Modifying the availability of pharmaceuticals (especially for poor and vulnerable populations) cannot be rushed.

• “Local experts and impacted populations must be part of the deliberations. We cannot leave decisions entirely up to recommendations of pharmaceutical benefit management (PBM) companies. PBMs have strengths, but they also have conflicting (and often opaque) loyalties.

• “The ‘rollout’ of any changes must be done in a well-orchestrated fashion. There’s no such thing as too much advance notice. Processes (and resources) need to be in place from day one.

• “The ethical and financial reasons for all decisions must be transparent and open to public debate.

• “Providers and patients must have clear and easy means to appeal.

“The initial implementation of Michigan’s Medicaid pharmacy plans fell short of these goals. We need to learn from these initial efforts in our work to better manage pharmacy utilization and cost.”