Value-based government? Protecting Medicaid? Changing Lansing’s climate? Not when it comes to the FY-12 budget recommendation of the Department of Community Health (DCH) to subject mental health medications to bureaucratic prior authorization procedures. The federal government has documented that 87 percent of adults with serious mental illness are prescribed medications. In fact, 35 percent receive only medications as their treatment. This is an area tremendously dependent on medication therapy. More than any factor, medication advances enabled society to dramatically reduce psychiatric hospital beds and treat people with mental illness in the community. This is also an area with great individual variability in how people react to medications. What works for Person A with schizophrenia may not work for Person B with the same condition. The area is further one where providers struggle with consumers maintaining medication compliance.

Numerous studies have found that mental health drug access restrictions interfere with consumer compliance, increase the likelihood of treatment drop-outs and cost more in the long run than any short-term “savings” achieved. Persons with serious mental illness who are untreated or inadequately treated are at risk of grave potential consequences like job loss, homelessness, justice system incarceration and early death - those with serious mental illness experience 25 years of lost life compared to the rest of the population. Treatment deficiencies also yield more hospitalizations, emergency room trips and visits to general medical practitioners.

With the above in mind, the Legislature unanimously included mental health drugs in a 2004 law protecting vulnerable populations against bureaucratic prior authorization procedures in Medicaid. The law (PA 248 of 2004) only applies to single-source brand products (i.e., there’s no generic equivalent). In other words, if a doctor wants to prescribe a brand for which a specific generic exists, Medicaid does not have to pay for the brand instead of the generic. The law only protects brand products for which no generic yet exists. The practical effect in 2011 is that the law is primarily protecting a small number of modern antipsychotics that don’t yet have generics but will over the next several years. The modern (“atypical”) antipsychotics are to the mental health field what the statin medications were to high cholesterol. In 2009, DCH convinced then Gov. Granholm to propose $6 million General Fund “savings” from a repeal of the mental health protections in PA 248 of ’04. The mental health community rose up against this proposal, and the Legislature did not attempt to change the law.

Legislators have recognized that if someone with serious mental illness has to fail twice on “preferred” products before a “non-preferred” one can be accessed, that person’s mind could be lost to us forever - or the individual could be dead. Now the unelected bureaucrats of DCH have resurrected the Granholm proposal, and Gov. Snyder has unwisely allowed them to do so. How many times do our elected officials and the mental health community have to stand firm before the bureaucrats get the message? Mark Reinstein is president & CEO of the Michigan Mental Health Association, a United Way- supported statewide advocacy organization.