The irony of trying to save Medicaid money might well result in more expensive human, medical and social costs, conclude the authors of a study of Medicaid management of medication. Medicaid drug policies, it seems, constrain access to preferred psychiatric drugs and thereby increase the likelihood of emergency room use, hospitalization or homelessness, say the authors of a new study in the May issue of Psychiatric Services. The authors base their conclusions, that drug management is based "based primarily on cost rather than on clinical considerations," on a 10-state study. The practices in question include substituting drugs for the prescribed and preferred medications, switching to generics, limiting dosages, or requiring "fail-first" policies -- not prescribing some drugs until patients failed first on others. Patient copayments and pre-authorization also contributed to interruption of taking medicine. Even in states with the least restrictions to access -- California, New York and Texas -- roughly one-in-five patients still had trouble with access.
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by Phyllis Vine
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