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Medicaid drug policy criticized

The state's new restrictions on mental health medicines will hurt patients, say officials at one drug company.

By LISA GREENE
Published June 28, 2005

New state policies restricting Medicaid payments for mental health drugs will hurt patients and drive up hospital costs, say doctors and a large drug company.

But state officials say that the drug company, Eli Lilly & Co., is trying to scare patients to protect its profits.

In recent weeks, Lilly has taken out full-page newspaper ads around the state saying the new restrictions could force stable patients with mental illnesses off drugs and into hospitals. Advocacy groups have gotten involved as well. The American Psychiatric Association put out a release saying the new policy will "create a statewide mental health emergency."

The state fired back Monday. Gov. Jeb Bush slammed drug companies that "create uncertainty and concern," while Alan Levine, secretary for the state agency administering Medicaid, blasted Lilly in a letter to the company's CEO.

"Intentionally creating fear and confusion among Florida's most vulnerable is a truly reprehensible strategy for protecting exorbitant prices," wrote Levine, secretary for the Agency for Health Care Administration.

What do doctors say about the new law, which requires that Medicaid patients first try drugs on an approved list and switch to others only if the first drugs fail?

"This is another second-class citizen type of slap at people with psychiatric illness," said Dr. Glenn Catalano, a psychiatry professor at the University of South Florida College of Medicine. "It doesn't seem like there's been a great attempt at understanding how these medications work."

By pushing patients toward certain drugs for which the state has negotiated a discount, officials hope to stem swiftly rising Medicaid costs. But some psychiatrists fear the new law could force stable patients to stop taking drugs that keep them healthy and productive.

Psychiatrists say patients respond differently to each drug - an effect more pronounced with psychiatric drugs than with those for, say, high blood pressure. Forcing a stable schizophrenic patient to switch drugs to save money is "a horrible idea," said Dr. Stephen R. Marder, a psychiatry professor at the Semel Institute of Neuroscience and Human Behavior at UCLA.

"It has the potential to destabilize the person," Marder said. "When a person with schizophrenia has a psychotic relapse, there's literature that shows it takes up to six months to return to their condition before that relapse."

That can mean expensive hospital bills, doctors said.

"It's essentially pushing costs to a different area," Catalano said.

Officials at the state agency say those fears are overblown. Patients who need costlier drugs will still be able to get them, Bush said.

"If doctors have tangible evidence that a particular drug that's not on the drug list is necessary, they have every right to request that drug be prescribed and reimbursed, and AHCA will reimburse it," Bush said.

The law allows patients who have tried the cheaper drugs without success to stay on a more expensive drug if it works for them.

"This is a campaign of misinformation," said Brandi Brown, the state agency's deputy chief of staff. "The state's intent is not to keep people off the drugs they need."

Levine and Bush say that Lilly is stirring up controversy because it doesn't want to negotiate with the state to discount its drugs, which include Zyprexa for schizophrenia, Prozac for depression and Strattera for attention-deficit disorder. It's the only one of 219 drug companies that has refused to negotiate with the state.

But a Lilly spokeswoman said the company is concerned about patients getting drugs they need.

If a patient had started taking a costlier drug when symptoms first appeared, without first trying the cheaper drugs, he or she would have to switch to the cheaper ones, agency officials said.

"How do we know they don't work if they haven't tried it?" Brown said. "A lot of these drugs are the same. They're just made by different manufacturers."

A state Medicaid committee is scheduled to discuss the list of preferred drugs Wednesday. Mental health advocates hope they will implement policies to allow all stable patients to stay on their drugs.

In his letter, Levine asked Lilly to negotiate with the state. That would create the potential for Lilly drugs to be included among those that patients could take first.

But such talks might not happen soon. Relations between the state and Lilly are so frosty that on Monday, Brown said, Lilly executives refused to give her a fax number to send Levine's letter.

--Times staff writers Lucy Morgan and Steve Bousquet contributed to this report.

[Last modified June 28, 2005, 04:26:26]