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Indiana Medicaid mental health list worries advocates

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A plan to cut Indiana Medicaid costs by limiting access to certain antidepressants, medicine for attention deficit disorder and other mental health drugs has advocates worried that some patients could be denied the treatment they need and end up in hospitals or even behind bars.

The state budget bill moving through the Indiana General Assembly would save about $7 million each year by creating a list of preferred mental health drugs and trying to win larger rebates from manufacturers. Groups representing doctors as well as patients and their families say it could endanger people with ADD, depression, schizophrenia and other mental illnesses.

"The money they're going to save, if you increase emergency room visits or you increase involvement in the criminal justice system, that money evaporates pretty quickly," said Mike Kempf of the National Alliance on Mental Illness-Indiana, who has a son with schizophrenia.

State Medicaid chief Pat Casanova pledged that health care experts — not bureaucrats — would be making the decisions about what medicines to approve, and that the determinations would come quickly. Indiana already has preferred drug lists for other diseases, she said, and her office found the state among only nine that do not manage mental health drugs.

A panel of pharmacists, health care professionals and academics review drugs when they enter the market and make recommendations to a second panel of experts that decides which of them go on the preferred drug list, Casanova said.

"It's not a clerk in an office or anything like that making a decision. It's a very thoughtful process," she told the Associated Press.

Medicaid enrolls more than 1 million Indiana residents in programs such as Hoosier Healthwise for children and pregnant woman, the Healthy Indiana Plan for uninsured, low-income adults and Care Select for people with disabilities. The state did not respond to a request for information about how many receive mental health medicines.

Under the bill, doctors prescribing drugs not on the list must seek prior authorizations that would be reviewed within 24 hours by Indiana Medicaid's pharmacy benefits manager, Casanova said. If the patient already takes a non-preferred drug, the doctor can provide a three-day supply while the authorization is pending. Psychiatrists would not need prior authorizations.

"We have no intent to cut people off drugs," Casanova said.

But that's exactly what some advocates fear. Stephen McCaffrey, president of Mental Health America of Indiana, noted that 60 of Indiana's 92 counties have no resident psychiatrists who would be able to prescribe drugs that are not on the preferred list. He also noted that Gov. Mitch Daniels' administration has tried to downsize state psychiatric hospitals and endorsed a report showing Indiana could save more than $1 billion over several years by moves such as steering lower-level felons into probation, community corrections and drug treatment.

"One of the tools in the toolbox to make those successful is to make sure there's appropriate access to medications in Medicaid," said McCaffrey, whose group includes doctors and consumers.

Indiana prison officials have said in recent years that nearly 20 percent of state inmates have been diagnosed with a mental illness and 12 percent take mental health drugs.

Ann MacLaren of Fishers, who has worked as a pharmacist in hospitals, retail, research and other areas, told the Indiana House Ways and Means Committee earlier this year there's no "one drug that fits all."

"Everyone is different and how we metabolize drugs is different," MacLaren said.

Beth Karnes, president of the Indiana Mental Health Memorial Foundation affiliated with McCaffrey's group, said that when bureaucrats interfere with seriously mentally ill patients receiving the medications that work best in them, it costs Medicaid more because of crisis care, emergency room visits and hospital admissions.

A 2008 study in Ohio estimating the cost of prior authorizations for certain mental health drugs found they would save $6 million but cause more than $18 million in adverse health consequences, Karnes said.

House Ways and Means Chairman Jeff Espich defended the preferred drug list proposal, saying Medicaid is the only part of Indiana's budget that's growing and is projected to reach $2 billion during the 2013 state fiscal year.

"We're at the point where we're looking to save pennies just because times are so tough for Hoosier families and the taxes they pay," said Espich, R-Uniondale.

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  • And The Hits Just Keep On Coming
    Like the author of Get A Grip!, and Mike Kempf, I have not one but TWO sons with a persistent mental illness, and it just burns my buns--to put it mildly, to see that "out of touch with REALITY decision makers, unashamedly, will presume to reduce BENEFITS of any kind to an already marginalized population! What's next, legislate morality, ha ha ha!---as laughable as their cruelty to trim access to certain medications that are proven to retard additional negative and/or monumental psychosis(es).
  • GET A GRIP !!
    ARE YOU SERIOUSLY KIDDING ME ? THIS SERIOUSLY UPSETS ME! AND THAT'S PUTTING IT MILDLY! WHAT IN THE WORLD ARE THESE BUREAUCRATS THINKING? OH, WAIT THEY'RE NOT THINKING!
    AS THE MOM OF A SON (who is on medicaid) WITH AUTISM, ADHD, ALONG WITH OTHER MENTAL HEALTH DISORDERS, I FIND THIS new bill TO BE TOTALLY STUPID (again putting it mildly). HE NEEDS HIS MEDS! IF HE LOSES HIS MEDS, HE WILL MORE THAN LIKLEY END UP IN THE HOSPITAL OR JAIL. I WOULD LOVE TO LEAVE HIM WITH THESE DANG BUREAUCRATS FOR A WEEK, WITHOUT HIS MEDS! AND THEN LET'S SEE HOW THEY FEEL THEN ABOUT CANCELLING MEDICATIONS FOR PEOPLE WITH MENTAL HEALTH DISORDERS!
    THOSE DANG BUREAUCRATS NEED TO GET A GRIP!!!
  • ILLEGALS
    Just cutting the funding for the illegals would put us way ahead of the game.Get rid of these parasites and watch Indiana prosper. No amnesty of any kind and bye bye anchor babies also. We have to do for the legal American citizens......
  • Here we go again.
    In the 80's Ronald Reagan cut spending to state mental hospitals. What this created was a homeless problem that doubled. When a reporter ask Reagan what he was going to do about the homeless his answer was. "Tell them to get jobs", the problem was most of these poor souls could not even function let alone get jobs. So now we cut money for their meds. Republicans who claim to be so moralistic really are just a bunch of thieves. A list of approved drugs and who has their hand in those drug companies pockets?

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