House Budget Bill Includes Provision Exempting Many Psychiatric Drugs From Effort To Steer Medicaid Beneficiaries to Less Costly Drugs

The House budget bill (HR 4241), which was approved earlier this month, includes a measure that would exempt mental health drugs from a provision for states to create Medicaid preferred drug lists designed to control costs, "ensuring that ... mental health drugs continue to fetch top price," the Washington Post reports (Weisman, Washington Post, 11/30). The bill, which was approved 217-215 on Nov. 18, includes about $12 billion in Medicaid cuts over five years (Kaiser Daily Health Policy Report, 11/18). The preferred drug list provision would permit states for the first time to charge higher copayments to Medicaid beneficiaries if they took drugs that were not on the list. However, Rep. Steve Buyer (R-Ind.) inserted an amendment under which states would not be able to limit access to mental health drugs unless they could prove to a drug review board that no harm would be done to patients. Patients with restricted access to mental health drugs would be able to appeal their state's decision, and if the appeal was not resolved within 24 hours, they would be granted a 30-day supply of the drug. The provision would increase federal drug spending by $125 million over five years, according to the Congressional Budget Office, while state officials "say they are likely to face far higher costs," the Post reports. Indianapolis-based Eli Lilly and other pharmaceutical companies, as well as mental health advocacy groups, lobbied for the provision.

Reaction
Mental health advocates said the provision is "necessary to ensure that vulnerable mental health patients receive proper treatment," the Post reports. Andrew Sperling, director of legislative advocacy for the National Alliance on Mental Illness -- which supported Buyer's amendment -- said, "We believe these (restrictive) policies are destructive and contrary to good clinical policies." However, House Energy and Commerce Committee Chair Joe Barton (R-Texas), whose committee approved the provision, and the National Governors Association, had "strenuous objections," the Post reports. Steve Ellis, a vice president and Medicaid analyst for Taxpayers for Common Sense, said, "This is obviously an attempt to prevent state Medicaid offices from getting cheaper, just-as-beneficial drugs to patients, and it's really going to stick it to the taxpayers." Some opponents of the provision have said it "underscores the excessive power that corporate interests wield in Capitol Hill," noting that Buyer's congressional district is adjacent to Lilly's Indianapolis corporate headquarters and that the drug company has been the largest corporate contributor to his campaigns, the Post reports. However, Lilly spokesperson Ed Sagebiel said, "This provision will help protect a vulnerable patient population and help ensure they receive appropriate medical care. On behalf of the patients, I ask, why is that wrong?" (Washington Post, 11/30).