a monthly public policy newsletter from the Mental Health Association in Michigan (MHAM)
Vol. 2, No. 2 February 2019
Important New Michigan Report on Medication Access Released
A report from a special, legislatively required workgroup on mental health medications has just been released. It supports the position MHAM and the behavioral health community have held for almost 20 years.
Since 2004, Michigan Medicaid has carved out from private Medicaid Health Plans (MHPs) the management of medications for mental health – and a small number of other chronic condition categories – with those medications managed by the state and not subject to bureaucratic prior authorization and step therapy (fail-first) procedures. This has been achieved by a combination of a 2004 state law, MDHHS policy and annual budget boilerplate language.
In the FY-19 MDHHS budget bill, the department was directed to convene an expert panel, primarily psychiatrists, to examine this situation and make recommendations. The then-legislator who spearheaded this was expecting the panel would say open access for mental health prescriptions was too costly and not scientifically warranted. He was wrong.
The workgroup consisted of six psychiatrists, two pharmacists, a family medicine doctor and the Presdent/CEO of MHAM.
Its report calls for the carveout of mental health drugs from the MHPs to continue. The report also calls for the carveout to be specifically stated for all of Medicaid in a single state statute so that the inefficiency of relying on three different sources of regulatory authority can end.
The panel cited some fascinating data provided it by MDHHS. In Fiscal Year-2017, 85-87% of Medicaid mental health carveout prescriptions were for generic drugs. (This percentage has risen virtually every year since at least 2010.) The same year, 99% of all prescriptions – not just mental health – carved out by MDHHS were for mental health, yet the mental health prescriptions only accounted for 62% of state costs across all drug carveout categories. The 1% of prescriptions for non-mental health categories represented 38% of all carveout drug spending. (The mental health volume percentage has been at 99% virtually every year since at least 2010, while its cost percentage has dropped from 90% in 2010.)
In other words, the mental health carveout is not at all the cost-buster that some legislators and MDHHS officials have branded it over the years. The workgroup wrote, “It is imperative to keep broader prescribing authority for practitioners…”
Additionally, “(The) data suggest that, if psychotropic medication costs strike some as ‘too great,’ it is because mental illness is so highly common in Medicaid. Ending the psychotropic carveout to eliminate the roughly 14% of prescriptions for brand products will not likely save major money. Curtailing access to psychotropics would not necessarily result in savings and could actually negatively impact quality outcomes for our general population and increase costs. The workgroup does not recommend curtailing access to appropriately prescribed psychotropic medication.”
The panel’s recommendation for revised state statute is similar to a recommendation of the state’s Section 298 Facilitation Workgroup. MDHHS has been asked several times what its position is on that recommendation. The response has always been that it will wait for the psychotropic workgroup, and the panel’s recommendations will be the department’s guide. Well, those recommendations are here now, so is the department going to support revised state statute? That is the only logical course now, but logic doesn’t always win out.
We will, of course, keep you posted on this critical issue.
To access the workgroup report, Workgroup Recommendations – Psychotropic Best Practices Workgroup, CLICK HERE.
Letter from Lansing is published monthly by MHAM. The primary mode of distributing the newsletter is electronic mail, but we will postal-mail copies to persons lacking Internet access. If you’ve come across this issue through a friend or colleague and wish to subscribe (there is no charge), kindly let us know. If at any point you wish to unsubscribe, simply contact our office.
Mental Health Association in Michigan
Mark Reinstein, Ph.D., President & CEO
Oliver Cameron, M.D., Ph.D., Board Chair
2157 University Park Dr., Ste. 1 | Okemos MI 48864
Phone: 517.898.3907 | Fax: 517.913.5941
firstname.lastname@example.org | www.mha-mi.com (membership available on-line)
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A United Way-Supported Agency, affiliated with Mental Health America