SPRINGFIELD – Mental health providers, patients and their families are fighting a state decision to restrict access to two anti-psychotic medications.
The Illinois Department of Healthcare and Family Services has said that after Oct. 17, Medicaid patients would no longer be able to get new prescriptions for Zyprexa and Seroquel without prior authorization from the state.
The medications are generally used to treat bipolar disorder and schizophrenia.
"As soon as I heard about this I was completely outraged," said Fannie Griffin, president of the National Alliance on Mental Illness for Champaign County and a school social worker and grief counselor.
"I cannot believe that they are trying to balance the budget on the backs of poor, disenfranchised people with mental illness. &We're just not going to put up with it."
Sandi Lewis, CEO of Mental Health Center of Champaign County, estimated that the policy change would affect about 300 individuals that are served by the center's two adult psychiatrists.
Kathleen Strand, spokeswoman for the Department of Healthcare and Family Services, said the new policy would not immediately affect patients who are currently taking Zyprexa or Seroquel.
The agency is giving automatic prior authorization for a four-month transition period to any patients in their databases who had requested those drugs within the last three and a half months, she said.
The transition period is to allow the patient's doctor to determine whether the individual may be switched to a different antipsychotic medication that is on the state's preferred drug list.
"There are going to be some good options for them to transition to if that's what needs to happen," said Strand.
If, however, the doctor believes that the patient cannot be moved to a different drug, he or she would then need to request prior approval from the state. Doctors would also need prior authorization to prescribe Zyprexa or Seroquel to any Medicaid patient who is not currently taking the drug.
The prior approval process can generally be competed in less than 24 hours, Strand said.
"If there's a sound clinical reason if the doctor submits to us, there's no reason why we wouldn't approve," she said.
The Department of Healthcare and Family Services has also installed a dedicated fax line for prior authorization requests and created a special form for urgent requests that could get the drugs to the patient "within hours," she said.
By requiring prior authorization for Zyprexa, Seroquel and the anticonvulsant Topamax, the state expects to save $7 million in the budget year ending June 30, 2006.
While trying to contain soaring prescription drug costs is important, Strand said, patient care was still the department's number one priority.
"Our first concern was a clinical evaluation of the effect of removing these drugs," she said. "We did a study on the impact on patient care and it concluded that a preferred drug list in these classes will not adversely impact patient care and, in fact, health care professionals believe that a preferred drug list can actually result in better outcomes."
The state's preferred drug list still includes four other antipsychotic medications and about 20 other anticonvulsants, Strand said.
In addition, she said the agency is eliminating Medicaid patients' copays for antipsychotic drugs, which had been a barrier for some of those individuals.
Clinical psychologist John Day said the new drug policy may save the state money in the short term, but it could end up costing more in the long run.
"There is no study that supports taking someone off a medication that is effective for him or her," he said. "This restriction is certain to result in harm to people with mental illnesses, their family members and their communities. It will impose higher costs on state, county and city governments when people become more mentally ill after being denied medication and need additional costly services, which may include hospitalization."
The Illinois chapter of the National Alliance on Mental Illness, which is observing Mental Illness Awareness week, is pushing the state to reverse its decision.
"Access to the right medication is a cornerstone of treatment, and treatment is the foundation for hope," said Lora Thomas, the organization's executive director.