NAMI Michigan

Dear Members of the Michigan Pharmacy & Therapeutics Committee:

In March, Michigan reeled from its dismal grade of D in NAMI National's Grading the States 2009 report—a disheartening drop from its C grade in 2006.  One bright spot that kept our state from sinking lower was our B grade in core treatment/recovery services.  Access to antipsychotic and other psychiatric medications contributed to Michigan's strong score in this category.

Even more compellingly, the Grading the States' online survey brought home the daily realities of individuals who live with mental illness and family members, including the following quote:  "She was able to finally receive the right medication for her illness which has made a huge difference in her being able to live a full life."  This quote represents what we hear over and over from persons who live with serious mental illnesses like schizophrenia, bipolar disorder, and major depression:  each individual responds differently to medications, yet the right medication can be instrumental in facilitating recovery.  This is why we are so strongly called to preserve access for psychiatric medications.

Just as it is important to understand the pivotal role atypical antipsychotics and other psychiatric medications can play in a person's recovery from serious mental illness, it is equally important to understand the dire consequences when people do not get the right help at the right time.  Mental disorders are the leading cause of disability for adults ages 15-44 in our country—greater than any other disease.  And, adults with serious mental illness served by our public mental health systems die, on average, at least 25 years earlier than the general population.  The significant disability and mortality associated with serious mental illness is precisely why psychiatric medications, like medications for cancer, HIV/AIDS, organ replacement therapy, and epilepsy and seizure disorders, have wisely been exempted from prior authorization in Michigan. 

Leaving disability and mortality aside, research shows that impaired access to or continuity of medications results in significantly increased hospitalizations, emergency department visits, homelessness and incarceration.  In fact, the Agency for Healthcare Research and Quality (AHRQ) reports that one in five hospital admissions have a primary or secondary diagnosis of a mental disorder.  And, as NAMI's Grading the States 2009 report notes, "Nowhere is the impact [of untreated or undertreated mental illness] felt more keenly than in Michigan's jails and prisons, where many individuals with mental illness end up incarcerated."

As members of Michigan's Pharmacy & Therapeutics Committee, you have the opportunity to help protect the health and well-being of the people of our state.  Over 400,000 adults in Michigan live with serious mental illness.  While many live successful lives of recovery, those who are covered by Medicaid due to a psychiatric disability are, by definition, individuals for whom previous treatment has failed to prevent a significant loss of functionality.  It is this population that represents our most vulnerable and who have the most critical need for unencumbered access to antipsychotic and other psychiatric medications.  Michigan's public mental health system has already plunged to a D grade.  We cannot afford to fall any further.  We urge you to act strongly to protect Medicaid enrollees and promote recovery by preserving access to psychiatric medications for those in need.
 
In closing, the Pharmacy and Therapeutics Committee has no legal authority at this time to make prior authorization recommendations about mental health medications. Public Act 248 of 2004 effectively removes any role for the Committee in this regard, and that law is still firmly in place. Action by the Committee July 21, 2009 would be premature and would violate the spirit, if not the letter, of the law."

Sincerely,

Sherri Solomon RN, BSN, MPA
Executive Director