Print

Email story

Comment

Email editor

Cutting a lifeline

The state is taking some high-priced medications away from Medicaid patients with mental illness. It's a cruel and unproductive way to cut costs.

As Florida government enjoys a financial windfall, poor people with schizophrenia may be about to lose the drug that keeps their lives functional. This is explained as a way to reduce soaring Medicaid costs, except that the political calculus and the bureaucratic response in this case are much too crude to be ascribed any noble intent.

The drug, Zyprexa, is currently prescribed to 16,000 Medicaid patients, most of whom suffer from schizophrenia. It is only one of several drugs that are being removed from the state's "preferred list" over the next two months, medications that are provided for people who suffer acute mental health problems.

"We understand the budget constraints and the disagreement between the state and pharmaceutical companies on how to approach this," says Susanne Homant, Florida chapter director of the National Alliance for the Mentally Ill. "But what we don't want to happen is to balance this on the backs of those who desperately need these drugs to live their lives."

So far, that seems be exactly what is happening. The Legislature simply established a bottom line this past spring. It told the Agency for Health Care Administration to cut its $2.4-billion Medicaid prescription bill by $292-million this year. Rather than turn to a prescription management plan that was showing some promise in reducing costs and curbing over-medication, AHCA instead told drug companies to drop their prices by 29 percent or lose state business. Eli Lilly & Co., which makes Zyprexa, was among the companies that so far have refused.

Meanwhile, as AHCA Secretary Alan Levine and Lilly executive vice president John Lechleiter swap intemperate accusations, the clock is ticking on some of Florida's most vulnerable citizens. The state says it is trying to cushion the impact by providing a two-month transition period (which began Monday) and by allowing doctors to petition for exemptions for individual patients. But the transition is shorter than its own panel of medical experts recommended, and the basis for individual appeal is ill-defined.

The state has previously removed some high-cost drugs from its Medicaid list, which prompted Senate Health Care Chairman Durrell Peaden to tell the Tallahassee Democrat recently that "nobody's died that I know of." But glib remarks don't serve people with bipolar mood disorders. The new drug restrictions apply to an entirely different category of drugs, include antipsychotics and anticonvulsants, for an entirely different category of patient. The clinical success is often the result of lengthy experimentation, as doctors prescribe a variety of drugs or combinations before settling on what works best.

Lawmakers now presume to play the role of mental health professional and deem that substitute, lower-cost drugs will work just fine. But the reality is that some of these Medicaid patients could experience relapses. They could face demons and delusions, turn against their loved ones or, worse, act out in violent ways. Then again, should they be convicted of crimes, the state will cover them. Unlike the Medicaid program, the prison system will continue to dispense Zyprexa and Zoloft and other drugs that help keep order in the minds of inmates and the cellblocks of state prisons.

Surely, there are more productive, let alone humane, ways to rein in the Medicaid budget.

[Last modified July 12, 2005, 01:26:22]