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Don’t Switch Meds, Advocates for Mentally Ill Tell State

Article by Erik Smith/ Washington State Wire. Published on Tuesday, October 26, 2009 EST.

Cost-Cutting Move Puts Patients, Public at Risk, They Say

 



By Erik Smith

Staff writer/ Washington State Wire

 

OLYMPIA, Oct. 26.—Efforts by the state Department of Social and Health Services to increase use of generic drugs are bringing a backlash from the psychiatric community and mental health advocates.

            Angered by a decision last week by the state Pharmacy and Therapeutics Committee to make a new generic anti-psychotic medication the state’s drug of first choice, they are calling for the state Legislature to reconsider the issue when lawmakers return to Olympia in January. Lawmakers this year ordered DSHS to drastically reduce spending on prescription medications by boosting usage of generic drugs from 63 percent to 83 percent.

            “I think it’s going to have a very serious long-term effect on patients,” said Jim Adams, past president of the National Association of Mental Illness for South King County and a member of a state advisory panel on mental-health drugs. “They’re all marching with the cost issue, and they don’t understand the pain they’re causing.”

            The issue is one of the key reasons behind the announcement by the Department of Social and Health Services earlier this month that it would not be able to hit the cost-savings targets mandated by the Legislature this year. Of $577 million in cuts ordered by the Legislature and the governor’s office, the department announced that $154 million in savings were not achievable. The drug program accounted for about a third of the problem – some $51 million. The department told lawmakers that it was a matter of educating physicians and patients about the use of generics, and it might take five to six years to achieve the goal.

            But mental health advocates and physicians say that’s not the problem at all.

 

            No Substitute for Some Medications

 

            The problem, they say, is that anti-psychotic drugs are not at all like most other drugs – because science has yet to understand exactly how they work. Some work better than others, depending on the symptoms. Until recently, the anti-psychotic medications have been one of the few classes of drugs for which no cheaper generic substitutes have been available, and the Washington state preferred drug list has given physicians their choice of eight brand-name drugs, Adams said. But because of that, anti-psychotics have accounted for about a quarter of the state’s prescription-drug spending.

But a pair of generics have recently come on the market – AdderallXL for adults, Risperidone for children with ADHD. The category accounted for much of the $51 million in savings that the Legislature and DSHS hoped to achieve.

            The decision by the Pharmacy and Therapeutics Committee phases in the two generic medications as the drugs of first choice for new patients. Meanwhile, a bill passed by the Legislature last year seeks to limit the leeway doctors have to prescribe non-preferred drugs.

Where anti-psychotic drugs are concerned, Adams and others argue that there is no substitute for a doctor’s judgment. Although the state policy would allow doctors to switch medications if the generics don’t work, Adams said mentally ill patients would suffer under a “fail first” policy. Currently doctors manage to prescribe the right drug about 80 percent of the time, but if the state says all Medicaid patients should get the same drug, he said odds are “five or six to one” that it’s going to be wrong. “Nobody looks at the human cost,” he said.

 

            State Defends Program

 

At last week’s hearing, Dr. Jeffrey Thompson, medical director of the state Health and Recovery Services Administration, which oversees the preferred drug list, said the decision will not affect those who are already receiving anti-psychotic medications through the state. “This is not about taking people off their medications,” he said. “This is about when a new client comes on board … is there an opportunity to steer them to generics first?”

            But others say the state is going too far. A stream of doctors, mental health advocates and clients themselves testified at last week’s hearing, arguing that access to the drugs should not be restricted. In a letter to DSHS, King County Sheriff Sue Rahr said, “if we use the correct meds to treat those who rely on us to protect them and others, then the chance of my deputies having to be put in a position where the loss of life could result will be decreased. The life of the suspect, our citizens, and the life of law enforcement personnel should not be placed in jeopardy over what a medication costs or whether or not it is on a list.”


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