Psychiatric drug changes pass state Senate

Mental health advocates haven’t gotten everything they wanted in relation to new state policies governing psychiatric medications for individuals receiving state assistance. But they scored a big win Monday night when the Iowa Senate approved new language that ensures existing patients’ medications won’t be automatically switched in order to save the state money.

As The Iowa Independent reported last week, mental health care advocates were upset that language removing protections for psychiatric medications purchased through Medicaid was included in the state reorganization bill. It was later discovered the language first emerged in a consultant’s report to the governor. They argued that the changes would result in small short-term savings but far greater long-term costs and unnecessary human suffering.

In light of their concerns, the Iowa Senate amended the bill Monday night, grandfathering in current patients receiving state assistance and adding a buffer period where patients can get medications while waiting for a state waiver.

“We are very pleased that the language was amended by the Senate for the consumers that rely on the Medicaid program for their psychiatric medications,” said Margaret Stout, executive director of the Iowa chapter of National Alliance on Mental Illness (NAMI).

An amendment to the nearly 300-page government reorganization bill was co-sponsored by Sens. Jack Hatch, D-Des Moines, and David Hartsuch, R-Bettendorf, two legislators who are not only from separate political parties but from vastly differing ideological perspectives. Their amendment specifically says that NAMI and other mental health patient organizations should and will have a voice in future policy development.

“Because these drugs have significant impact on disabled individuals, we allowed NAMI to be invited to participate in the rulemaking authority — which they could normally, of course, but we wanted to specifically invite them,” Hatch said while introducing the amendment.

Hartsuch acknowledged to his fellow senators that policy decisions regarding psychiatric medications should be as open as possible due to their impact on society.

“I think we all agree that those individuals with mental health problems be able to get their medications in a very expedited fashion, and I believe this amendment brings input from the mental health community in a manner that it should,” said Hartsuch, a Scott County Republican.

The amendment was approved by voice vote, and no dissenting votes could be heard in the chamber.

“This is one of the first times that I’m aware of in Iowa that actually allows for direct consumer/family input into the decision of psychiatric medication formulary for mental illness treatment for the Medicaid population,” Stout said. “It goes without saying that we are very pleased. Quite frankly, the consumer/family voice is missing in most areas of medication formularies for mental health care that is delivered in our state.”

A bill now requires the state to continue to pay for medications of any Medicaid mental health patient that had a drug regiment in place prior to Jan. 1, 2011, the effective date of the changes, regardless of whether the prescribed drug appears on the preferred or non-preferred list. Although previous language was rigid, requiring every manufacturer of psychiatric medications to enter into a rebate program with the state or have its medications automatically placed on the non-preferred list, new language provides greater flexibility in this area.

“The purpose [of adding more mental health drugs to the preferred drug list] is to save public money without undermining the availability of mental health medications for people receiving Medicaid,” said Roger Munns, spokesman for the Iowa Department of Human Services. “We know that some people worry about losing drugs that they believe are working, which is why we support the amendment to grandfather current prescriptions. The change would apply only to new prescriptions.”

Legislators also allowed physicians to prescribe a 7-day supply of mental health medications while awaiting prior authorization from state authorities, and made direct note that if an “approval or disapproval is not received by the physician or other prescriber within 48 hours of the request, the request is deemed approved.”

Munns previously told The Iowa Independent that the process for obtaining prior approval was not cumbersome, and often took less than two hours. Advocates, however, cautioned that the process could become more intense and labor-intensive as more medications lost their existing waiver and were placed on non-preferred status by the state. Due to the direct language of the bill, both mandating that mental health advocates have a seat at the policy table along with state agencies and automatically issuing approval if the process is lengthy, it is much less likely that budget constraints will dictate access to these medications.

State officials have estimated that roughly $400,000 in yearly savings could be obtained by eliminating an existing waiver and subjecting psychiatric medications to preferred and non-preferred drug lists. Medications for the treatment of cancer, organ transplant and HIV/AIDS will continue to be granted a waiver and will not be placed on preferred drug lists by the state.

The amended bill now goes before the Iowa House where it could face additional scrutiny and changes. If so, it will come back before the Senate for re-approval before being sent to the governor’s desk.