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SPONSOR: |
Papen |
DATE TYPED: |
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HB |
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SHORT TITLE: |
Medicaid Mental Illness Medications |
SB |
822/aSPAC/aHGUAC |
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ANALYST: |
Weber |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or
Non-Rec |
Fund Affected |
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FY03 |
FY04 |
FY03 |
FY04 |
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See Narrative |
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(Parenthesis
( ) Indicate Expenditure Decreases)
Responses
Received From
Human Services Department (HSD)
Department of Health (DOH)
Regulation and Licensing-Board of Pharmacy (RLD)
SUMMARY
Synopsis of HGUAC
Amendment
The House Government and Urban Affairs Committee
amendment makes the following changes.
These changes make new subsection D read:
The
department shall ensure that atypical antipsychotic medications are available
in the same manner as conventional antipsychotic medications for medicaid
patients being treated for severe mental illnesses that are listed in a current
national diagnostic and statistical manual of mental disorders published by a
national psychiatric association, including schizophrenia, clinical depression,
bipolar disorder, anxiety-panic attack disorder and obsessive compulsive
disorder."
The revised language negates the original intent of
Senate Bill 822. This amendment omits
the prior authorization exemption for drugs prescribed for mental illnesses
which was a key element of the original bill.
Synopsis
of SPAC Amendment
On page 2, line 10, strike “being treated” and after
“for” insert “the treatment of”. This
Senate Public Affairs Committee amendment does not change the intent or
potential impact of Senate Bill 822.
Synopsis
of Original Bill
Senate Bill 822 (SB 822) would amend Section 27-2C-3 NMSA
1978 to add a new subsection (D) stipulating that requirements for prior
authorization shall not apply to prescription drugs – including atypical
anti-psychotic and conventional anti-psychotic medications – that are prescribed
for Medicaid patients being treated for severe mental illnesses that are listed
in the Diagnostic and Statistical Manual (DSM).
The bill also makes slight revisions to clarify language in subsection A
and a reference in subsection C.
Significant
Issues
HSD
notes that Section A of SB 822 calls for the implementation of a preferred drug
list (PDL) , “taking into consideration the clinical efficacy, safety and
cost-effectiveness of a product”. This is a dynamic, clinically current
document, which would be unduly constrained under Section D. If science-based
research fails to substantiate clinical efficacy, or raises safety or
cost-effectiveness concerns, this section would hamper efforts to constrain
potentially inappropriate uses of drugs.
DOH offers a slightly counter view indicating
that many individuals with severe mental illnesses require ongoing use of
antipsychotic medications that currently require prior authorization. This
authorization review often interferes with the timely provision of appropriate
and beneficial therapy. In addition, the
repetitious prior authorization process interferes with efficient and effective
treatment. RLD concurs and states this
change provides faster treatment for those patients with severe mental illness
and potentially save lives.
FISCAL IMPLICATIONS
The fiscal impact is
indeterminate but it is assumed that less restrictive drug management will
result in increased Medicaid pharmacy expenditures.
MW/sb:njw