Tag Archives: Susana Martinez Administration

Expanded Medicaid to Restrict Psychiatric Medication?

Update: It is apparent that this is in fact still happening and expanding to more patients and more programs. That they have decided to expand this national dereliction of duty and institutionalized malpractice to Medicaid is born out by the concerns expressed in the New York Times article Plan to Limit Some Drugs in Medicare Is Criticized

Leaders of numerous patient advocacy groups said they were worried that patients could be harmed if the policy changed.

“The proposal undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries,” said Andrew Sperling, a lobbyist at the National Alliance on Mental Illness.

Under the proposal, Mr. Sperling said, a Medicare drug plan could have a list of preferred drugs with just two medications to treat schizophrenia. That is inadequate, he said, because antipsychotic drugs work in different ways in the body, and have different side effects. “You get much better outcomes when a doctor can work with patients to figure out which medications will work best for them,” he said.

As I had stated originally, I have been receiving disturbing reports regarding New Mexico Centennial Care’s disastrous roll out. I am prompted to share some of these issues due to a dire situation that appears to be a national Medicaid policy that I recently learned of. I have my own experiences with the so called “Medicaid Expansion” to share, but first the alarming situation of restricting psychiatric medications for those who need them.

Mental health has been in the national news a lot lately with all the mass shootings at schools and other public places. New Mexico made the list with the Berrendo Middle School shooting in Roswell. The nightly news is full of domestic violence, homicides, and other violent crimes. Perfect timing for restricting psychiatric medications. Since my original write up, New Mexico has received national attention for the “U.S. Department of Justice finding that the Albuquerque Police Department engages in a pattern or practice of excessive force in violation of the Fourth Amendment of the United States Constitution.” – koat.com

Encounters between Albuquerque police officers and persons with mental illness and in crisis too frequently result in a use of force or a higher level of force than necessary. The DOJ said the problems dealing with mental health is a failure of the entire community and needs to be addressed. – koat.com

What is so concerning in light of all this is that I am hearing direct patient reports that over the past month (January/February), a majority of psychiatric patients have been required to get a pre-authorization  in order to receive their medications. Many patients are going without medication as this process can sometimes take weeks. The entity that is reportedly enacting this practice is Presbyterian Health Plan, Inc. (see the Drugs Requiring Prior Authorization, and the What if my drug is not covered? pdfs, under the Prescription Drug Benefits section at that link. Those are the documents that are being used to restrict psychiatric medications from many New Mexicans in need).

Presbyterian Health Plan, Inc. has set up a system where insurance providers are effectively prescribing alternate medications to patients without seeing the patient or consulting with the patient’s physician. What is happening is that doctors are prescribing medications and if those are not on an approved list, the medicine is not covered and the patient is left to either take a medication that does not work for them and that their doctor has not prescribed, obtain the money for expensive medications on limited income, or go without.

This situation is based on eyewitness reports. Updates will be posted as they arise.

When is it ever a good idea to restrict psychiatric medication from patients in need?

Sources

Agave Health, Inc.
https://www.agavehealth.org/

Expanding Health Coverage for Low Income Adults: The Medicaid Opportunity under the Affordable Care Act (ACA)
http://conalma.org/wp-content/uploads/2013/06/EP-Medicaid-Expansion-and-Centennial-Care-2013.06.pdf

Koat News
http://www.koat.com/news/us-department-of-justice-releases-findings-on-albuquerque-police-department/25413344#ixzz2ymCBcbLn 

New Mexico Centennial Care
http://www.hsd.state.nm.us/Centennial_Care.aspx

Plan to Limit Some Drugs in Medicare Is Criticized
http://www.nytimes.com/2014/02/22/business/plan-to-alter-medicare-drug-coverage-draws-strong-opposition.html?partner=yahoofinance&_r=0

Presbyterian Health Plan, Inc.
https://www.phs.org/insurance-plans/our-plans/employer-offered-plans/Pages/state-of-new-mexico.aspx