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In an editorial in the current Psychiatric Services, William M. Glazer, MD from the Department of Psychiatry, Massachusetts General Hospital, Boston presents some of the concerns about preferred drug lists (PDL) that are currently in use in many states. The trend in various state budgets has been to save money by creating a PDL for Medicaid. This list directs physicians to use less expensive medications that are deemed to be equally effective. He points out that in the last 2 years, the number of states that are using PDLs has changed from 3 to the current number 22.
The process, in most of the states, typically involves a committee of clinicians, administrators and regulators who review the evidence base and often conclude that similar agents "are equally effective and [they] eliminate the most expensive ones from the PDL." None of the individual differences in the way patients respond (or don't respond) to medications are taken into account. Dr. Glazer points out that there is insufficient evidence about how these agents compare with each other over the long term. Another important issue to consider is the impact of drug acquisition costs on the total treatment costs or on the quality of life of the recipients and their loved ones.
The editorial suggests that while it is important to cut costs, using PDLs for patients with severe mental illness is premature and amounts to rationing medications. Since it is difficult to predict which medication or combination of medications work best for an individual, patients should have access to all medications. A coalition to advocate for open access to psychiatric medications was formed by the American Psychiatric Association, the National Alliance for the Mentally Ill and the National Mental Health Association. Dr. Glazer states that what is needed are 'best practice models' to ensure that there is 'transparency in decision making and public accountability for the quality of care that ensues from all rationing decisions.' More research is needed especially long-term comparative studies. He succesfuly points out that there are many more consequences to these issues than cost savings and hopefully the states will evaluate all of the facts before making such decisions.
MedAccess Online
Psychiatric Services, June 2004
APA Advocacy Bulletin - Medicaid in Crisis
FDA Office of Generic Drugs
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