| Efficacy studies have demonstrated time and again that the effective prescription and use of
appropriate neuropsychiatric drugs reduces morbidity and costs in the long run, and that the earlier in the course
of a brain disorder an effective medication is used, the greater its effectiveness. For the good and welfare of
the largest number of people, the California Psychiatric Association recommends that managed care companies and
health insurance carriers be precluded from restricting a patient's access to any effective central nervous system
medication where the patient's physician has determined that the patient would benefit from that medication. The
California Psychiatric Association supports legislation allowing any drug that is approved by the federal Food and
Drug Administration to be approved for addition to the list of drugs covered by either Medi-Cal, Medicare, or
health care plans for the purpose of treating psychiatric disorders.
The California Psychiatric Association believes that such legislation will be cost-effective and good social
policy. Due to the severe side effects associated with medications presently included on the Medi-Cal list of
contract drugs, and the drugs allowed by some managed care plans, for the treatment of psychosis and psychiatric
disorders, many patients are unwilling to take the medications. In addition, some newer and more expensive drugs
are much more effective. Allowing the use of the most effective drugs with the least side-effects may cost more
out of pocket originally than providing a limited formulary. However, studies show that total expenditures for the
treatment of psychosis and psychotic disorders, including nonpharmaceutical services such as hospitalization (or
incarceration) are not less expensive for states with restricted formularies.
March 20, 2003: The above policy was adopted in 1997. At the date of this note, all of the newer
antipsychotic medications were on the Medi-Cal list of contract drugs, usually called a formulary, and are covered
by state Medi-Cal for patients. Although all of the newer antidepressants are also on the state Medi-Cal
formulary, individual medications may or may not be readily accessible to individual patients, as those
medications are obtained from local managed care plans, which may or may not include an individual medication on
its list of preferred drugs. |
