A DANGEROUS BUDGET CUT

A DANGEROUS BUDGET CUT

By Mark Reinstein

It's deja v all over again

In 2004, mental health advocates and providers worked hard with legislators to protect mental health drugs from the prior authorization that was required in the state's Medicaid program. We wanted an end to the dangerous situation whereby medications gained “preferred” Medicaid status only through cost considerations, and doctors and consumers had to seek approval of the “nonpreferred” prescriptions for a non-profit company in Virginia

This bureaucratic nightmare agreed that this was unsound policy, likely to cost more in the long run than anything it might save, and in no way help vulnerable citizens with serious brain disorders. Both the House and Senate unanimously adopted, and the governor signed, Public Act 248 of 2004. This law states that if a mental health drug has no generics and is not a controlled substance, Michigan Medicaid cannot subject that product to prior authorization.

Even in crisis times, when an important, popular and politically significant program is threatened with elimination because of $2 million, cost is not really the issue. Something else is going on, and whatever that something is, mental health consumers, their families and all of Michigan will suffer if we have to return to the pre-2004 days when decisions about how to treat devastating conditions like schizophrenia and bipolar disorder were left to administrators, not clinicians.

But 30 to 60 days on the wrong drug for mental illness can leave a person in a state of chronic severity—even possibly in the justice system, a psychiatric hospital, a homeless shelter or the hospital emergency room repeatedly. It can even mean death. The research evidence on the costly outcomes of restricted medications is even stronger today than it was in 2004.

Is all this worth trying to save $2 million in a state general fund budget of over $8 billion? Of course not. Officials in the governor's office and the state Medicaid program should stop acting like petulant children who couldn't get their way in 2004. And the legislature must stand up to them.