Recently, the Illinois Medicaid program limited prescription drug coverage for several medications because of the high expense of the drugs in a move to control spending in mental health care. This policy change allows most of those already receiving Medicaid prescription assistance to be grandfathered in, and consumers prescribed the drugs not on the state's preferred list may still receive those medications with authorization.
Many mental health advocates have cried foul, but their concern for people with mental illness misses a key point. Until now, the State allowed physicians to prescribe any psychotropic medication regardless of the cost. Taxpayers should appreciate that allowing a physician to prescribe every expensive psychotropic medication does not readily translate into helping those with a mental illness. The perfect drug does not always hit the bulls eye. Research has shown that for those with severe and persistent mental illness, recovery comes not solely by finding a well-tolerated, effective drug. Persons with mental illness must be part of a system of care designed to meet their needs for housing, employment and reintegration into the community.
Many mental health advocates have cried foul, but their concern for people with mental illness misses a key point. Until now, the State allowed physicians to prescribe any psychotropic medication regardless of the cost. Taxpayers should appreciate that allowing a physician to prescribe every expensive psychotropic medication does not readily translate into helping those with a mental illness. The perfect drug does not always hit the bulls eye. Research has shown that for those with severe and persistent mental illness, recovery comes not solely by finding a well-tolerated, effective drug. Persons with mental illness must be part of a system of care designed to meet their needs for housing, employment and reintegration into the community.
Proponents of the cost-cutting correctly say it will help the state manage fiscal responsibility in health care, forcing providers to find lower-cost and equally effective options for those with mental illness. Still, a larger issue remains for persons coping with mental illness. The state, while cutting spending for certain drugs, must prioritize the "wrap-around" services that community behavioral healthcare can provide. These services include supports for housing, therapeutic and outreach services, physical healthcare, and employment services. Good treatment means inspiring people to make important and rewarding contributions to society.
With this in mind, the state should continue to prioritize a holistic and cost-effective approach to addressing mental illness that doesn't simply throw money towards pharmaceutical companies promising the next big thing in mental health treatment. However, without proper therapeutic care such as community support and physical healthcare, along with housing assistance to prevent homelessness and employment services to help those with mental illness find and keep a meaningful job, even the most expensive, innovative and trustworthy drugs will have less overall effect to prevent the negative outcomes of long-term mental illness.
-- Steve Weinstein, M.D., Chicago
With this in mind, the state should continue to prioritize a holistic and cost-effective approach to addressing mental illness that doesn't simply throw money towards pharmaceutical companies promising the next big thing in mental health treatment. However, without proper therapeutic care such as community support and physical healthcare, along with housing assistance to prevent homelessness and employment services to help those with mental illness find and keep a meaningful job, even the most expensive, innovative and trustworthy drugs will have less overall effect to prevent the negative outcomes of long-term mental illness.
-- Steve Weinstein, M.D., Chicago
Chicago Tribune September 12, 2011
While I agree with Dr. Weinstein that a completely "laissez-faire"
ReplyDeleteattitude on the part of the state with regard to expense of medications is inappropriate, the state has gone much too far in the other direction. Further, rather than releasing funds for other types of services for the emotionally disturbed/behavior disorder community, these cuts have been accompanied by huge cuts in mental health services in general for this community.
I, myself have been adversely affected by similar cuts in Medicare; I have been taking 40 mg. lexapro for at least 12 years, have improved both my health and life on THIS MEDICATION ONLY, after having used MANY other anti-depressants, and not only have I been able to complete a 4-year certificate program at the University of Chicago,I have developed many new interests and relationships, and finally received an academic appointment. Even more important, I have not ONCE entertained a suicidal thought on 40 mg lexapro, whereas I had been plagued with them all my life (64 years) previously. Now the state says the maximum dose is 20 mg., and suggests substitution of celexa, which is cheaper. It is very difficult to get a waiver, and my physician has not succeeded so far. This has produced such a setback for me, that I cannot sleep at all many nights and am sleepy (for the first time ever) during the day. This disruption in my sleep schedule and drowsiness has affected me so much that I may have to go to a hospital soon, as I am so depressed.
I consulted with Dr. Weinstein once, and found him extremely insensitive to my needs. he said, "You don't need a genius for a psychiatrist." While this may be LITERALLY true, I have found that
it takes an extremely intelligent and compassionate physician to find the right combination of medications for a patient. Throwing generic xyprexa at everyone who walks into your office, is both ineffective and harmful-- it causes extreme weight gain and sometimes diabetes, and is often neurotoxic. I , for one, have relied greatly on my right to choose exceptionally intelligent and sensitive physicians, whose skill in prescribing may be unorthodox, but makes me ABLE to avail myself of the variety of services such as those that Thresholds provides! The medications the state would have me take, as opposed to those my extremely skilled physician prescribes, not only HELP me much more, but SAVE the government the money that just a few days in the hospital would cost!
So, Dr. Weinstein, I think that having the state "prescribe," which amounts to practicing medicine without a license, is not only not helpful, but probably ultimately more expensive! And this, I predict, will end up with our community not being covered for ANY
medicines AND fewer other services (if any)!
actually practicing medice