Summit Urges Passage of House Bill 2469–Carve out psychotropic medications from 4-drug limit

Representative Chapa LaVia has introduced House Bill 2469 to carve out  many psychotropic medications from the draconian 4-drug limit on Medicaid recipients imposed by last year’s SMART Act.  The SMART Act includes a provision requiring Medicaid recipients to get prior authorization from their doctor for any prescription medications over four per month.  This means each month Medicaid recipients who receive over four medications would be required to have each doctor for those additional prescriptions send paperwork to the Department of Healthcare and Family Services justifying those additional prescriptions.  Each month the prescription and doctor could be different depending on the order the prescriptions are sent to the pharmacy.  This creates a burden on the patient, as well as burdens on the doctor and the Department of Healthcare and Family Services.  Unfortunately many persons with mental illnesses and their doctors, when  faced with the burdensome prior authorization process, simply give up and then the person’s mental health condition deteriorates.  Over 200,000 Medicaid recipients take over four prescription medications.

The costs of this provision will outweigh any savings the legislature was hoping to gain.  The Summit is suggesting a number of possible changes to ease the burden o the Act in its current form.

  • Eliminate the four-drug limit entirely.
  • Amend the SMART Act to exempt from the four-drug limit persons who are on Medicaid due to a disability.
  • Amend the SMART Act to exempt psychotropic medications, or at least, exempt anti-psychotic and anti-depressant medications.
  • Improve the prior authorization process:
    • Create an electronic (email or web-based) submission process.
    • Increase transparency by publishing standards and procedures for prior authorization.

If you would like to help please contact the state legislators involved in the enactment of this Act (contact information for each provided in the links below): Senator Heather Steans (D), Senator Dale Righter (R), Representative Patti Bellock (R), and Representative Sara Feigenholtz (D).

For more information please see the links below.

Letter to personalize and send to your state legislators

Click key legislators names for contact information:

Senator Heather Steans (D)                       Senator Dale Righter (R)

Representative Patti Bellock (R)              Representative Sara Feigenholtz (D)

The SMART Act in its entirety; the 4 drug limit is in provision 305 ILCS 5/5-5.12 Pharmacy Payments

Summary of Driscoll and Fleeter research

Driscoll & Fleeter for NAMI Ohio research discussing the rise of costs under a prior authorization program

Exclusion of Antipsychotics from Four Drug Limit_Fact Sheet

CBHA report on the effect of the 4-drug limit so far (October, 2012)

The Illinois Department of Healthcare and Family Services Annual Report for FY11; this report was used by Thresholds in addition to the Driscoll & Fleeter research to apply it to Illinois

Report showing magnitude of co-occuring mental and physical illnesses

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3 thoughts on “Summit Urges Passage of House Bill 2469–Carve out psychotropic medications from 4-drug limit

  1. I just recently filed the first federal lawsuit in the United States challenging the propriety and constitutionality of a Governor’s authority to restrict Medicaid recipients to a certain number of monthly medications. The federal judge gave my lawsuit the green light to proceed on 9/12/13 and the Governor and other state officials responsible for this travesty are in the process of being served with the lawsuit. I believe the 4 prescription limitation is patently contrary to federal Medicaid laws and the U.S. Constitution. Like I said, the lawsuit is the first in the United States on this issue. There are 12 other states who have placed similar limits on monthly meds for their Medicaid recipients. If my lawsuit is ultimately successful it could set precedent. I am very confident the 4 prescription limit will be struck down by the federal court. I need to hear from people affected by this 4 script limit. I also need support from the community. Anyone who wants to help please contact me at: robciarpaglini@yahoo.com.
    Thanks.

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