Kelly Sloane
Amidst the hail of criticism of medical spending, we sometimes hear about the costs associated with mental health treatment. As with the rest of healthcare, the great innovations of the last 50 years have come from the pharmaceutical industry, so we are primarily talking about the cost of drugs.
In recent years, something called “step therapy” has been promoted. This is a practice in which insurance companies (or Medicaid) require patients to try several inexpensive drugs before covering a doctor-recommended one. The idea is simple and designed to keep treatment costs down. Instead of defaulting to the most expensive drug on the market, try some cheaper options first. If Honda gets the job done, why choose Cadillac first?
But as the French say, “une fausse idee claire”. A great idea that doesn’t work – at least not universally, in the case of people with severe mental illness (SMI).
The key to step therapy is that the patient must fail many times before the drug actually recommended by the doctor is finally approved. Tolerable as it may be, failure to treat may reduce quality of life somewhat, but it is unlikely to have catastrophic consequences.
It’s another story when talking about serious mental illness. Think about it: What happens to people with schizophrenia, severe depression, and paranoia when treatment fails? Can they continue to function in society? keep working? Take care of yourself or children? Do you interact with others responsibly? Stay clean and sober? Fentanyl-splattered homeless camps continue to pop up across the city, riddled with failed mental health treatments.
Considering the possibility of harming others, the discussion takes a more ominous turn. Every time there is a mass shooting, we argue with each other over petty issues. We are desperate for any means of proactively identifying those who pose the most danger to society. What we do is effective mental health treatment, provided it is available to anyone diagnosed with SMI.
State legislatures have taken several steps to make mental health medications available to patients and deserve consideration.
What HB1130 does is limit the number of failures before patients in the commercial market (ie small group and individual plans) receive medically recommended treatment. The SMI’s step therapy protocol reasonably states that you cannot try more than one drug before your doctor’s training and expertise covers the one drug he prescribes. Making new FDA-approved SMI drugs available to Medicaid patients by requiring the Department of Policy and Funding (the cute acronym HCPF) to review such drugs for inclusion on the Medicaid Preferred Drug List Streamline your processes. 90 days from FDA approval.
SB33 applies similar logic to the Medicaid side that HB1130 applies to the commercial insurance market. For SMI Medicaid recipients, SB33 removes virtually all barriers to existing treatments, including step therapy and pre-approval. This latter element not only recognizes that physicians are not paid to do extra paperwork, but also that patients with heart disease or arthritis, for example, need to receive the care they need. We recognize that we may be willing to do anything. A Day to Get the Acknowledgment You Need – People with severe depression who struggle desperately to face life’s simplest challenges are far less likely to negotiate such obstacles.
For those of us who are more financially minded, there are also financial considerations. Local Economic Consulting Group Analysis of Step Therapy’s Impact on Patients Diagnosed with Major Depressive Disorder in Florida Costs him $271.5 Million in Health, Workplace, Suicide and Tax-Related Costs in the State I know you went up.
I can understand why the insurance industry pursues treatments such as step therapy. It is not due to the greedy evil inherent on their part. They do so because so many deplorable decisions of the government – mass compensation obligations, price controls, etc. – have forced them to grasp whatever they can. It’s wrong.
Colorado legislators should support these measures. Because, if for no other reason, by showing concern for people with serious mental illnesses, by the grace of God, we are showing concern for where any of us are going.
Kelly Sloan is a political and public relations consultant and convalescent journalist based in Denver.
