Statement by the National Council for Behavioral Health on the Missouri House Budget Committee vote on HB 986
Repealing protections in current law that ensure access to psychiatric medication
On behalf of the millions of Americans living with mental health disorders, their families and communities, the National Council for Behavioral Health urges lawmakers in the Missouri House of Representatives to reject proposed legislation that would repeal language protecting Medicaid recipients’ access to mental health medications (HB 986). Should this repeal be enacted, patients could lose access to lifesaving medications, with potentially devastating effects. Consistent with our longstanding support of policies that support patients’ access to all FDA-approved psychiatric medications, we encourage lawmakers to preserve the protections in current law.
Antipsychotic medications are not clinically interchangeable, and providers must be able to select the most appropriate, clinically indicated medication for their patients. Patients respond differently to different antipsychotic medications, and it can often take several trials and many months to find an appropriate drug regimen that stabilizes an individual’s condition. For people with serious and persistent mental illness or those suffering from co-morbid conditions, providers must be able to select from a full range of drug options so as to maximize treatment efficacy, minimize side effects, and avoid drug-to-drug interactions.
Exempting all FDA-approved antipsychotics from prior authorization is the only way to ensure that vulnerable patients can always access the treatment they need. Other states that have repealed their mental health exemptions or instituted stringent utilization management techniques have found that they did not fulfill the projected savings. For example, Maine did not realize any savings in its pharmacy budget after taking this route. In fact, limiting access to medications has a spillover effect, increasing expenditures in other areas of the state budget. Pharmacy benefit management techniques such as prior authorization also create undue burden for prescribers.
Research clearly indicates that consumers who are unable to access the most appropriate, clinically indicated psychiatric medication experience higher rates of emergency department visits, hospitalizations, and other health services. Policies such as prior authorization that restrict choice and access to medications have been shown in multiple studies to cause increases in hospitalizations, lengthier hospital stays, more emergency room visits, more outpatient hospital visits, and more physician visits – and this base of evidence continues to grow. Rates of suicidal behavior and homelessness also rise among consumers who report difficulties accessing their needed medication.
These outcomes are not only bad for consumers, they are typically far more expensive to Medicaid or other state agencies than the cost of covering antipsychotic medication or outpatient behavioral health visits. The National Council supports public policies that ensure that all consumers have access to the right treatments at the right time. For this reason, we strongly recommend that Missouri lawmakers preserve current law ensuring patients’ full access to all needed mental health medications.
About the National Council for Behavioral Health: The National Council for Behavioral Health is the unifying voice of America’s mental health and addictions treatment organizations. Together with over 2,800 member organizations, serving 10 million adults, children and families living with mental illnesses and addictions, the National Council is committed to all Americans having access to comprehensive, high-quality care that affords every opportunity for recovery. The National Council was instrumental in bringing Mental Health First Aid to the USA. In 2014, the National Council merged with the State Associations of Addiction Services (SAAS). To learn more about the National Council, visit www.TheNationalCouncil.org.