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As the calls to reduce the cost of Medicaid have become louder and louder, the costs associated with prescription drugs, which now represent a large portion of all Medicaid costs, continue to be a prime target. This year, Governor Pataki has once again proposed the implementation of a Preferred Drug Program (PDP), as part of his 2005-06 budget proposal, which would effectively restrict access to certain medications in an effort to cut Medicaid costs.

Basically, the PDP would require pharmaceutical companies to provide the state with financial incentives in order to get their medication(s) on the list of 'preferred' drugs that doctors would be permitted to prescribe to Medicaid patients. The Preferred Drug List would be developed by a special committee and only after receiving permission would a doctor be able to prescribe a drug not on the preferred list. This proposal, while well-intentioned to save money, would be devastating to Medicaid recipients with mental illness in their ability to get the medications they need.

As has been proposed in previous years, atypical anti-psychotic, anti-depressant, anti-retroviral and anti-rejection medications would all be carved out of the provisions for the PDP. While we in the mental health community greatly appreciate this, it unfortunately does not go far enough. Many of the medications for bipolar disorder, anxiety disorders, and other disabling mental illnesses, and all of the medications prescribed to deal with the negative side effects of many mental health drugs would still be subject to the PDP. In addition, when considering the fact that more than 50% of individuals with a serious mental illness have co-occurring serious physical illnesses as well, even with the exemptions listed in the Governor's proposal, a PDP would create a tremendous strain.

Under the proposal, a special committee would be given sole discretion in determining which drugs would be subject to the PDP. As we all know, the mantra of the consumer movement has been, "Nothing about us without us." The creation of this committee stands in direct contrast to consumer empowerment in that it appears as though there would be no consumer representation required on the committee. Furthermore, given that mental health is an area of medicine so distinct from other fields, it's also disturbing that there is no required representation from the mental health professional community on the committee either.

Doctors treating Medicaid patients would have to go to extraordinary lengths to prescribe non-preferred drugs they feel are most appropriate for a patient. Doctors would be forced to get prior authorization from the state to prescribe a non-preferred drug. Doctors would have to confirm that an emergency condition indeed exists before prescribing an emergency supply of a medication not on the preferred list. The additional obstacle of obtaining prior authorization may well discourage doctors who are already contending with overburdened caseloads and low reimbursement rates for Medicaid patients from trying to prescribe drugs not on the preferred list. Additionally, it appears that doctors who do make the effort to get prior authorization still have no guarantee that their request won't be denied anyway.

Perhaps of greatest concern to individuals with mental health needs is the creation of a Clinical Drug Review Program (CDRP), which would effectively create a separate PDP within the PDP. This would allow the language exempting atypical anti-psychotics and anti-depressants to potentially be sidestepped. The CDRP would consider nothing other than cost to determine which medications would be restricted and would require the doctor to obtain prior approval. Knowing that medications to treat mental illness are indeed expensive, mental health drugs, including the atypical anti-psychotics and anti-depressants exempted from the PDP, would likely be restricted via prior authorization under the CDRP.

The CDRP would also restrict access to medications not clinically indicated for a particular disease or population, effectively removing the flexibility physicians currently exercise to prescribe medications that would be effective. Under this scenario, if the CDRP were to be enacted, the new pharmaceutical technologies that have proven useful in areas other than where they were intended would be greatly restricted. This would have a tremendous impact on the ability of physicians to prescribe anti-depressants and other mental health drugs for children, for example.

It is clear from the experiences of other states that have implemented such programs that restricting access to medications within the Medicaid system has resulted in terrible impacts, even resulting in the death of some Medicaid recipients. Douglas Schmidt, a 36 year-old man from Portland, Oregon, suffered a massive seizure eight days after he lost access to the anti-convulsant he was taking. When Medicaid no longer would pay for his medication, he wound up in a coma in the hospital where he relied on machines to keep him alive for 8 and a half months at a cost of nearly $1 million. His family was forced to make the difficult decision to remove him from life-support after Oregon decided it would not pay the $13 a day necessary for Douglas to remain healthy.

Admittedly, the cost of prescription drugs has risen significantly in recent years. However, we must consider the fact that these medications have allowed thousands of individuals with mental health needs to successfully transition from psychiatric centers into communities, saving our state billions of dollars each year. These same medications allow individuals with mental health needs to live healthy, productive lives. When restrictions are placed on these medications the impact will surely be devastating.

Only by exempting the person with the chronic condition, and not the pills they are taking, can we begin to address the consumer protections that would be necessary for even a basic bill. There is absolutely no clinical evidence indicating that a PDP would improve the quality of care for Medicaid recipients. With that in mind, it appears that the only good PDP is no PDP. Working together, we can stop the PDP!

Please consider taking just a few moments to contact the Governor and your representatives in Albany to let them know that you oppose the PDP. You may either send your legislators an email using MHANYS Online Advocacy tool at http://www.mhanys.org/policy/advpld.htm or by calling your representatives in Albany:

Governor Pataki – (518) 474-8390
Your Senator – (518) 455-2800 – Ask for your Senator
Your Assemblymember – (518) 455-4100 – Ask for your Assemblymember

To find out who your Senator and Assemblymember is, go to http://map01.elections.state.ny.us/boe/main.asp.

Tell them: "Please don't try to save pennies per pill by restricting access to vital medications for New Yorkers on Medicaid. There is no clinical evidence that implementing a Preferred Drug Program will improve the quality of care for Medicaid recipients. Please protect access to the proper medications for all New Yorkers by rejecting the Governor's Preferred Drug Program proposal." And if you can, share with them your own personal experience and how medications have helped to improve your life.