State Medicaid Restrictions on Mental Health Drugs and their Effect on Access to Treatment

Tula Michaelides, MPH, Health Policy and Payer Relations Group, PAREXEL MMS, 5870 Trinity Parkway, Suite 600, Centreville, VA 20120, 703-310-2041, tula.michaelides@parexel.com

Over the past few years, states have increasingly been implementing measures to help to control Medicaid costs. These measures have included implementing prescription drug formularies, prior authorization requirements and supplemental rebates. The drug formularies are usually devised by state review boards that divide drugs into therapeutic classes; the review panel then designates what they deem to be the most cost-effective drugs per class. In the case of drugs to treat depression, bipolar disorder and schizophrenia, many mental health advocacy groups have argued that formularies and other drug limits are burdensome to mental health consumers and make it difficult for an already vulnerable population to obtain the medications they want and that are prescribed by their doctors.

This presentation will delineate which states have a formulary/preferred drug list/prior authorization requirement for the various classes of mental health drugs (e.g., selective serotonin reuptake inhibitors for depression, atypical antipsychotics for schizophrenia and bipolar disorder, etc.), and which drugs are notably included or excluded from these lists. The presentation will also discuss the implications of these limits on access to the wide variety of pharmacologic treatments for depression, bipolar disorder and schizophrenia.

Learning Objectives:

At the conclusion of the session, participants will be able to

1. Identify which states have imposed preferred drug lists, prior authorization requirements or supplemental rebates for the various classes or mental health drugs under the Medicaid program.
2. Discuss which mental health drugs are excluded from the various states’ preferred drug lists and formularies.
3. Articulate how these Medicaid restrictions have affected mental health consumers, particularly with regard to treatment access.

Keywords: Mental Health, Medicaid

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Mental Health Poster Session III

The 132nd Annual Meeting (November 6-10, 2004) of APHA