By John Tote
Special to the Post
Far too often in the health care debate ó especially with regard to mental health ó policymakers have made knee-jerk decision based on political calculations and short-term fiscal concerns, with little regard for the very real consequences to patients. Granted, times like these require difficult decisions to be made quickly, but as we’ve seen time after time in the case of mental health, decisions can be undertaken with an unbelievable lack of foresight and, sadly, are often based on social stigma.
The General Assembly is trying to save money on Medicaid. We need to make sure any cost-saving measures do actually decrease overall state spending, and not at the expense of the most vulnerable in our society.
The state Senate’s failure to include “carve out” language exempting mental illness medications from a proposed Preferred Drug List would be disastrous on both accounts. It would actually drive up costs to the state, and it would put people with mental illness at potentially grave risk. The House should act now to include an exemption for mental health patients in its budget.
A preferred drug list places restrictions on which medications Medicaid will cover. If people with mental illness are not exempted from the list, they will have a much harder time getting the medications they need to function.
Restricting access to mental health drugs can be especially harmful because there is not a wide array of options available, whether brand name or generic. If we restrict access to the small handful of drugs upon which these individuals rely, their conditions can deteriorate rapidly.
The result would be a potential loss in the quality of life for those with mental illness and would affect not only their mental health but also their physical health. Instead of having access to the right drug first, they could be subjected to medication whose side effects are often horrendous. The devastating “fail first” provision of most preferred drug lists requires a patient to try a number of lesser drugs before receiving the correct one. For those receiving mental health care, the unevenness of this approach often causes more harm than good.
North Carolina would likely see a rise in costs if access to key prescription drugs is restricted. When mental health patients do not have the proper medicine, they can encounter serious health problems that land them in the emergency room, homeless, in the criminal justice system or in a very costly state psychiatric hospital. All of these scenarios cost the state significantly more than providing the right drugs.
Access to proper medication for Medicaid patients is just one of the many problems facing individuals with mental illness in North Carolina. There are cracks in the system, and countless patients fall through them each year. Let’s not allow changes to the state’s Medicaid program be yet another obstacle in the fight to ensure our most vulnerable members of society receive the care they need.
Traditionally, North Carolina has maintained significant protections to ensure the availability of mental health medications for the poorest in our state. That commitment is now threatened. It is time to speak up for those who so often cannot speak up for themselves. The Generally Assembly needs to protect access to prescription drugs in the Medicaid program ó for all our sakes.
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John Tote is executive director of the Mental Health Association in N.C., Inc.