National Alliance on Mental Illness
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February 21, 2003






The NAMI Board of Directors has recently adopted a comprehensive federal and state strategy to ensure open access to medications in the current budget deficit environment.

Prior authorization and other cost containment mechanisms have appeared in state legislation, appropriation bills and regulations and pose significant threats for Medicaid recipients with mental illnesses trying to access medications prescribed by their treating physician.

We believe the following, primary approaches are critically important to the financial health of your state and to your public mental health system:

  • NAMI opposes the use of Medicaid prior authorization programs to control prescription drug costs and utilization. NAMI believes that Medicaid prior `authorization programs are high-risk cost containment strategies and they are not an effective cost-management strategy based on private sector experience.
  • If prior authorization programs are in place or being strongly considered, NAMI supports carve-outs for anti-psychotic, anti-depressant, anti-anxiety and anti-convulsant medications from restrictive cost control programs in order to ensure that people with mental illness have open access to medications that maintain recovery.
  • NAMI emphatically opposes the use of fail-first provisions prior to authorization of state-of-the-art psychiatric medications. This "dark age" approach forces a consumer to fail on a treatment before being allowed access to the medication that his or her physician would have tried as the initial medication. This causes unnecessary suffering, wastes state public funds, and increases the likelihood of relapse.
  • NAMI supports an increase in the "Federal Medical Assistance Percentage," or FMAP to get states through these difficult financial times. Cutting back on Medicaid spending will result in severe service, infrastructure and community impacts due to the loss of federal funds. We are supporting efforts of the National Governors Association and others to increase the Medicaid matching rates.
  • NAMI supports appropriate, emerging legislative initiatives to expand prescription drug coverage for Medicare beneficiaries. We believe that state pressure to control prescription drug spending will mount in the absence of a Medicare drug benefit.

In addition to the these policy recommendations, NAMI advocates should try to make the link between tax and revenue decisions and spending decisions, and help legislators develop credible and principled revenue solutions that are fair, broad-based. NAMI recognizes that the state’ tax revenues have been falling sharply and Medicaid costs are increasing dramatically. However, policymakers should not balance state budgets on the backs of its most vulnerable citizens by limiting access to medications which is essential for recovery from mental illness. Limiting access may result short-term budget gains, but denying necessary treatments will show up in other areas of the state budget.

NAMI’s Policy Research Institute has developed five state alerts on the four major policy areas the NAMI Board of Directors addressed, as well as state tax issues. We hope these bulletins provide you with appropriate guidance for your discussions with state officials.

The Institute has also prepared a draft statement or testimony that can be tailored by advocates for use before legislative hearings, press conferences, P&T Committees and other meetings.

For further information, please contact Mike Fitzpatrick at (207) 353-9311 or Joel Miller at (703) 524-7600.