State of Florida to Force Patients to Try Cheaper Mental Health Drugs

The American Psychological Association’s news service carries a report from the New York Times indicating that new Medicaid regulations in the State of Florida will force patients to use cheaper mental health drugs, even if they are already stable on a costlier medication.

Long-time visitors to CounsellingResource.com will know that we are highly critical of the exorbitant prices charged by many US pharmaceutical companies, and of the protectionist attitude of some parts of the US government that continues to force US consumers to pay higher prices for prescription drugs than consumers in any other part of the world. On the face of it, government moves to reduce profiteering by the pharmaceutical industry sound like a good thing.

But then I read that the State of Florida has enacted a new law requiring that Medicaid patients first try drugs on an approved list and switch to others only if the first drugs fail. (The new regulations for Medicaid payments for mental health drugs are only one part of a larger strategy for reducing state medical costs, a strategy which also includes negotiations with drug manufacturers to secure special pricing.) The requirement, however, is far more stringent than that; the New York Times quotes a state Medicaid official as saying that “If a patient had started taking a costlier drug when symptoms first appeared, without first trying the cheaper drugs, he or she would have to switch to the cheaper ones”. Brandi Brown, the state agency’s deputy chief of staff, said:

“How do we know they don’t work if they haven’t tried it? A lot of these drugs are the same. They’re just made by different manufacturers.”

It would be one thing for the State of Florida merely to second-guess the clinical judgement of physicians, by requiring that medications be tried in an order specified by the State (from cheaper to costlier); but it is quite another for the State of Florida actually to require that patients who are already stable on one medication be forced to change to a different (cheaper) medication just to see if it works.

To my mind, the idiocy of this policy — promoted aggressively by Governor Jeb Bush — is so appalling that it almost defies comprehension. While the US government largely has itself to blame for the exorbitant pricing of prescription drugs in the United States, it makes no sense to me at all to seek cost savings at the margins by forcing stable patients to switch to alternative medications just in case they might work.

In this particular case, I believe it is Gov. Jeb Bush’s administration which is suffering from muddled thinking, attacking the very real problem of pharmaceutical profiteering by putting innocent patients in the firing line.

In a press release, the American Psychiatric Association says the new policy will “create a statewide mental health emergency”.

Well done, Gov. Bush.

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