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Don’t limit access of mentally ill to meds

Experience can be a useful teacher for N.C. lawmakers – in this case, it’s the experience of Pennsylvania.

Pennsylvania did what the N.C. Senate is proposing as part of its budget bill. The Senate’s budget plan would require doctors for Medicaid patients to get prior authorization – approval by a Medicaid reviewer in the state’s managed-care program – for all mental health drugs.

Last November, a Pennsylvania 15-year-old who has paranoid schizophrenia attempted suicide after new Pennsylvania regulations did not allow her primary-care doctor to prescribe the medications she needed. The problem came as a result of prior authorization requirements for prescriptions for anti-psychotic drugs, doctors said. Those new rules said doctors must get prescriptions approved by the state before a pharmacy can fill it. That process sometimes took months and added unnecessary paperwork. It also led to patients being off their medications, creating risky situations.

A study by the American Psychiatric Association confirmed problems. More than 61 percent of psychiatrists in Pennsylvania reported having patients who experienced difficulty in accessing prescribed medications due to the prior authorization requirement. In New York state, where mental health medications are not subject to prior authorization, just 27 percent reported difficulties.

The problems in Pennsylvania led Republican lawmaker Bryan Cutler to push through legislation to exempt psychiatrists from the state’s pre-authorization for prescribed medications. Said Cutler: “Psychiatrists generally treat individuals who have more severe mental illnesses, and prior authorization can act as a barrier to care for these vulnerable patients.”

Medical professionals, advocates for those with mental illnesses, and the mentally ill themselves echoed that at a rally at the N.C. Legislative Building in Raleigh last week. Holding signs that proclaimed “Don’t mess with our meds!”, they urged lawmakers to reject the prior authorization plan. The effects could be devastating, putting patients and the public at risk.

We don’t have to look far to see the tragic consequences of people not on medications they needed for their mental disorders. The Aurora, Colo. theater rampage and the Virginia Tech slayings readily come to mind.

Durham psychiatrist Bryce Reynolds told the (Raleigh) News and Observer a study showed that 29 percent of participants who were required to obtain prior authorization for their medications discontinued treatment – and of those, 80 percent relapsed. That study also showed that hospitalization rates and emergency department visits increased when patients were required to get prior authorization for medications. So this move would likely raise costs and not be the money-saver some legislators claim.

An online petition to N.C. legislative leaders is already circulating, noting that a similar measure was passed in Maine and “Medicaid saw nearly a 20 percent rise of patients going over 30 days without their medicine.” Reynolds said some patients stop treatment altogether after missing their medicine. “As a result of that, it leads to more hospitalizations, more emergency room visits, more homelessness, more incarcerations, violence,” he said.

That means added costs to the state.

This is a pound-foolish move. Listen to the experts and learn from experience, N.C. lawmakers. Reject this proposal.

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