Advice for Advocates
At the APA annual meeting presentation titled “Medicaid Policies on Outpatient Prescription Drugs: A Survey and Discussion of Advocacy,” Chris Koyanagi, policy director of the Bazelon Center for Mental Health Law, advised mental health advocates to encourage states to do the following:
Include more than one drug in a class on a preferred drug list (PDL). | |||||
Permit “grandfathering” of medications that are not on PDLs for people with chronic conditions. | |||||
Consider making the use of PDLs voluntary for physicians. | |||||
Promote appropriate cost savings, such as the use of generic drugs, when substantiated by expert opinion. | |||||
Consider pooling prescription-drug purchases with those by other states to gain additional rebates. | |||||
Target polypharmacy when it is misused. Missouri and Massachusetts state officials use Medicaid prescribing data to identify physicians whose prescribing practices are expensive and of questionable efficacy and to direct voluntary, educational efforts to them (Psychiatric News, November 21, 2003; May 16, 2003). | |||||
Avoid the use of limits on the number of prescriptions that can be filled in a given period. In New Hampshire, costs exceeded savings by a factor of 17 when state officials put a limit of three per month on prescriptions for antipsychotic medications. The additional costs were in the form of emergency mental health services, partial hospitalization, and visits to community mental health centers, according to the September 8, 1994, New England Journal of Medicine. | |||||
