* April 14, 2011…

The Illinois Medicaid agency recently cut costs by moving numerous medications, including several anti-psychotics, to a non-preferred list. Some mental health advocates are saying the agency’s action will come at a high price for people with chronic conditions such as bipolar disorder and schizophrenia.

The Illinois Department of Healthcare and Family Services, the state Medicaid agency, maintains a list of preferred and non-preferred prescription drugs for patients, with mostly generics left on the preferred list. Effective April 1, the agency re-categorized a number of medications, including several name brand atypical anti-psychotics, as non-preferred. That means doctors who want to prescribe them to patients on Medicaid will have to obtain prior authorization from the department first.

This may result in people with chronic mental disorders not getting the specific medication they need, said Mark Heyrman, a professor at the University of Chicago law school and the facilitator for the Mental Health Summit, a coalition of mental health advocates and providers. As a result of going untreated, they might end up hospitalized or in jail, he said.

“This is a real risk for people with mental illnesses,” he said.

* August 15, 2012…

In the past two years, Illinois has done just about everything it could to reduce the amount it spends on prescription drugs for mental health. It has placed restrictions on the availability of 17 medications used to treat depression, psychosis and attention-deficit disorder. Doctors now have to explain to Medicaid why the drugs are necessary before a patient can get access to them. Then in July, as part of an effort to cut overall Medicaid spending by $1.6 billion, the state capped the number of prescriptions for Medicaid recipients to four a month, even if they previously were taking a broader cocktail of behavioral medications.

In financial terms, there is no question that it has worked. Last year, the state’s Medicaid mental health drug spending budget was reduced by $112 million. The new cap on prescription drugs is expected to save another $180 million.

Up until 2011, behavioral health drug spending made up about a quarter of Illinois’ Medicaid prescription drug costs. The state spent about $392 million that year on drugs for treating mental health patients. In fiscal 2012, the state spent $280 million on mental health drugs.

But what are the implications for quality of care? Some physicians argue that they are disastrous. “It’s a mess,” says Dr. Daniel Yohanna, a psychiatrist at the University of Chicago Medical Center. “People who were stable on some drugs have been unable to get them. It has created a significant problem.”

* July 22, 2014…

A team of researchers published data Tuesday in the American Journal of Managed Care showing that prior authorization policies in Medicaid programs have significantly higher rates of severe mental illness in their prison populations.

Schizophrenics living in states with prior authorization requirements in Medicaid were 22 percent more likely to be jailed for a non-violent crime than those in states without those restrictions.

“What’s novel in this paper is documenting a link between Medicaid policy and prison populations that’s never previously been looked at,” says Darius Lakdawalla, a professor at University of Southern California and study co-author says. […]

Another paper Lakdawalla has worked on, published this spring, found that states with prior authorization policies tended to see their spending on hospital spending go up faster. The idea here is that patients who didn’t receive anti-psychotic medication may have ended up having to take more trips to the hospital in order to control their symptoms.”In that respect, Lakdawalla says, “It doesn’t seem like you’re getting a lot of bang for the buck in reducing health care costs. There is collateral damage.”

The researchers don’t claim to prove that prior authorization policies cause higher rates of incarceration among the mentally ill. But what Lakdawalla does see in this study is a space for further exploration, of whether these Medicaid policies are having the unintended consequence of driving up incarceration rates of the mentally ill.

“From a policy perspective, this suggests there may be a link between underfunded mental health systems, criminal activity and cost-shifting onto the prison system,” he says. “It’s probably not all about prior authorization, but could be the larger mental health spending picture.”

…Adding… From Rep. Greg Harris…

Your post on the consequences of budget cuts relating to anti-psychotic meds for Medicaid patients and crime/incarceration and mental illness is one of the major reasons that we removed anti-psychotic drugs from the prior authorization list in SB741 that became effective July 1.

I am still working with providers and DHFS on other issues related to what drugs go on the preferred drug list of the formulary such as Concerta and Abilify, and even a quirk in policy that was brought to my attention by Lurie Childrens hospital yesterday that when Medicaid patients turn 19 there is a problem with continuation of ADHD medications.