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Cuomo budget proposal riles mental health advocates

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A proposed change to the state’s mental hygiene law has mental health advocates fearing the state’s quest to cut costs will put treatment of the mentally ill at risk.

In his 2013 executive budget Gov. Andrew M. Cuomo proposed eliminating the “prescriber prevails” policy from the mental hygiene law.

Mental health advocates say the proposal that effectively strips doctors of the ability to prescribe Medicaid patients the atypical antipsychotic drugs they need if their health plan manager hasn’t established it as a preferred drug.

Advocates are calling on the governor to include the exemption for atypical antipsychotic drugs that was codified in last year’s budget bill.

Glenn Liebman, CEO of the state Mental Health Association, said the current law allows physicians to have the final say on what drugs their patients receive.

“The physician can overrule the Medicaid provision within the health plan,” he said.

But Mr. Cuomo’s proposal would give health plan managers, not physicians, the final say on mental health medications.

“This is rather sweeping,” said Arthur J. Clark, professor and coordinator of the Counseling and Human Development Program at St. Lawrence University, Canton. “It certainly doesn’t make a lot of sense to me.”

Mr. Clark said the problem with Mr. Cuomo’s proposal is that it essentially places the power of prescribing medication in the hands of health plan managers who aren’t physicians and who don’t know a patient’s mental health background.

“It puts patients at risk,” Mr. Clark said.

There is an appeals process within the governor’s proposal, but Robert Valadez, policy analyst at the Gay Men’s Health Crisis, New York, said that with some types of medications the appeals process, which could take weeks, has the potential to be devastating. He said that is especially true for patients also taking drugs for HIV and AIDS.

If a patient is off their antipsychotic medication for too long, or if they are taking the wrong type, they may also miss other regiments they need to be on.

“With HIV medication, it’s so finely tuned that if they wait two to three weeks it can have drastic impacts on the client,” Mr. Valadez said.

Morris Peters, a spokesman for Mr. Cuomo’s budget division, said the proposal will not threaten the well-being of mental health patients.

Citing the built-in appeals process, Mr. Peters said, “What we’re trying to do here is protect patients from the misuse of antipsychotic drugs.”

Mr. Peters also said the savings from removing the “prescribers prevail” provision will help keep Medicaid fiscally responsible.

“It certainly is understandable to reduce costs and control costs, but at what cost?” Mr. Clark said.

Mr. Clark said Medicaid is already saving money by stressing preference in prescribing lower-cost generic medication whenever possible.

“It seems to me, if you have a physician with the right background, they can easily prescribe the generic drugs on their own,” he said.

Sandra Tomalty, secretary of the National Alliance on Mental Illness in St. Lawrence County, said people with mental illnesses are “already are being given generic drugs unless there is no generic for the medicine.”

As for removing the “prescribers prevail” policy, Mr. Clark said the savings may be relatively minimal, only several million dollars statewide.

“Ultimately it’s not going to save money because the reality is, if somebody doesn’t get access to their medication, they could be hospitalized,” Mr. Liebman said.

He said the cheapest way to deal with mental health issues is to ensure effective and efficient access to the correct medication.

“If you’re putting patients at risk, this doesn’t make sense,” Mr. Clark said.

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