NAMI Michigan

In 2004, mental health advocates and providers worked hard with legislators to protect mental health drugs from bureaucratic prior authorization 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 “non-preferred” prescriptions from a for-profit company in Virginia.  This bureaucratic nightmare often resulted in prescription denials until a consumer failed twice on alternate, cheaper medications.

The Legislature agreed that this was unsound policy, likely to cost more in the long run than anything it might save, and was no way to 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.

The state’s Medicaid program has never been happy with the law.  Instead of accepting the will of the Legislature and moving on to other important business, state Medicaid officials have periodically gone on fishing expeditions, looking for legislators who might be willing to overturn Public Act 248.  No Michigan legislator has ever introduced repeal language, but now Michigan Medicaid and the Governor’s office are using the state’s economic difficulties to ratchet up the pressure on lawmakers, telling them it’s vital for the state’s economic situation that Public Act 248 of ’04 be repealed.

This is a most ironic claim because, by the Department of Community Health’s own admission and figures, there are cost-saving steps that could be taken right now under Public Act 248 that would leave the state only $2 million short (General Fund) of what the department projects it could otherwise save if given unfettered control of mental health drug prior authorization.

Michigan is in an economic crisis, but 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 the pre-2004 days when decisions about how to treat devastating conditions like schizophrenia and bipolar disorder were left to administrators, not clinicians.

More than any other factor, advances in medication made possible society’s shift from institutional treatment to community care for serious mental illnesses.  But there is great variability in how mental health drugs affect different people; what the side effects are going to be; and whether an individual will stay on the same medication and dosage indefinitely or have to make periodic adjustments.  The need for such adjustments is common, which makes Medicaid’s offer to grandfather existing prescriptions this time around far less significant than might appear at first glance.

If you have high blood pressure, having to fail on the wrong drug may have no significant, lasting life effects.  If you have type 2 diabetes, 30 days of being on an ineffective medication will likely leave you plenty of room for a different, more efficacious drug to do its job. But 30-60 days on the wrong drug for mental illness can leave a person in a state of chronic severity, in the justice system, in a psychiatric hospital, in a homeless shelter, in the ER repeatedly, and in the public mental health system at taxpayer expense long-term.

The research evidence today is even stronger than when the Legislature acted in 2004. When we create restrictions on medication access, some people will wind up with no medications at all.  And too many people with serious mental disorders will be harmed because they’re not receiving medications or are getting ones that don’t work for them.  Not only will they and their families pay a terrible personal toll, but society will pay as well.

Is all this worth $2 million in a state General Fund budget of over $8 billion.  Of course not.  But there are two entities in Michigan who think so – the Governor’s Office and the state Medicaid program. They should stop acting like petulant children who couldn’t get their way in 2004.  And the Legislature must stand up to them.  There is a one-in-three chance that someone in your family has mental illness.  Would you want a phone technician in Virginia empowered to overrule your loved one’s doctor on what medication is needed for that mental illness?