Not Enough Drugs?
The problem with such limits is that few studies compare the ability of different drugs to treat severe mental disorders. Doctors often wind up treating patient on a trial-and-error basis, balancing sometimes severe side effects with the drug's intended action, says Darrel A. Regier, director of research at the American Psychiatric Association.
"You're basically tying the hands of your best clinicians," he says. "You'd basically set psychiatry back 30 years" to a time when doctors had very few options for treating severe disorders.
Medicare is due to issue final rules on its planned drug formulary by January 2005, an agency spokesperson says. Medicare currently recognizes 209 different drug classes in its discount drug card program, though private pharmacy insurance companies often cover far fewer.
In a statement, Medicare chief Mark B. McClellan, MD, suggested that the agency would closely scrutinize drug formularies to make sure that they cover needed drugs.
"It makes no sense to create a new prescription drug program that does not cover the drugs seniors take. It is critical to note that by law, the drug benefit must not discriminate against the needs of the Medicare beneficiary, regardless of their health problems," he says.
Medicare is also due to take over the drug costs of approximately 1 million mentally ill patients who now get drug coverage under state Medicaid programs. Some of the programs already have rules requiring prior authorization for drugs not on the state's formulary list, but many have no restrictions.
Patients with state coverage now could run into trouble if they are forced to stop or switch their drugs when Medicare takes over in 2006, says Michael F. Hogan, PhD, director of the Ohio Department of Mental Health.
"Stability for them is a big concern," Hogan says in an interview, noting that failure to take prescribed medications is a leading cause of relapse for severely mentally ill persons.
Groups representing patients with many other disorders have also voiced concerns that Medicare's rules could restrict their access to needed drugs.
A Medicare spokesperson says that the agency "reserves the right" to scrutinize all final drug formularies before the benefits take effect.