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.
Click key legislators names for contact information: