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Michael Petruzzelli

, National Council for Behavioral Health

Study Finds Medication Restrictions Significantly Affect Mental Health Outcomes

November 13, 2014 | Uncategorized | Comments
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A new study administered by the National Council for Mental Wellbeing and the National Alliance on Mental Illness (NAMI) found many common insurance and state Medicaid medication restrictions may negatively impact patient health and impose a major workload on psychiatrists that takes time away from patient care and other important duties.

More than 50 percent of psychiatrists surveyed practicing in community mental health centers pointed to formulary restrictions, prior authorization and step therapy protocols as the most frequent roadblocks to prescribing an optimal treatment regimen. Step therapy protocols are sometimes referred to as “fail first” policies, as they only allow psychiatrists to pursue different drug options after other treatments fail to help patients. These policies burden providers with additional bureaucracy, spending time which could otherwise be used treating patients. One in ten psychiatrists reported spending 40 percent or more of their time on utilization management-related administrative tasks.

“Our research shows that many obstacles continue to limit mental health providers’ ability to effectively provide care,” says Dr. Ruth Shim, one of the study’s authors. “The next step is to take policy action to remove these barriers to increase access to and quality of care for individuals living with mental illnesses.”

Most importantly, the study found medication restrictions directly impact patient wellness. Three-quarters of psychiatrists state that patients had trouble complying with medication plans, while 62 percent said patients experienced increased emergency department visits, hospitalizations, and increased health care costs. Increasing medication options will provide better care and improve patient results according to those surveyed.

“Mental health treatments are not one size fits all,” said Linda Rosenberg, President and CEO of the National Council. “Choosing the right plan should be the decision of a patient and their doctor, not rigid health plan policies. Increasing options, reducing paperwork and restoring physician authority ultimately results in better patient care.”

“The survey confirms what individuals and families affected by mental illness know from direct experience,” said Mary Giliberti, NAMI’s executive director. “Having a choice of medication is critical for positive outcomes. Too much time is being spent on needless authorizations rather than treatment. Policy change is needed to empower individuals and their doctors to make the right choices based on personal needs and goals, rather than on lists and failures.”

The study was jointly funded by a grant from Sunovion, Takeda Pharmaceuticals, and Lundbeck, LLC to the National Council and NAMI.