Kentucky mental health groups are working towards persuading state officials to make an expensive new anti-schizophrenia drug called Zyprexa more available to Medicaid patients.

Kentucky Medicaid patients who have schizophrenia or other psychoses like manic depression can get Zyprexa now. However, a "pre-authorization" process requires them to try older, cheaper drugs first. If those drugs don't work, psychiatrists then can prescribe Zyprexa. Kentucky, California and Georgia are the only states with this policy.

But mental health advocates are clamoring for Kentucky Medicaid officials to put Zyprexa on an "open drug" list so that doctors could prescribe it immediately, and not require patients to use other drugs first. They say that Zyprexa works better than the older drugs, and with fewer of the side effects that often cause patients to stop taking the medications. They also say the state would save money in the long run because Zyprexa, though more costly than some drugs, would help keep more patients out of Kentucky mental hospitals.

"We feel this is a winnable issue, and we're determined to win it," declared Angie O'Malley, president of the Bluegrass Chapter of the Kentucky Alliance for the Mentally Ill.

O'Malley says Medicaid's current policy is a hardship for many patients because they may have to spend five or six months trying cheaper drugs before Zyprexa.

But Duane Dringenburg, director of Medicaid's individual clinical providers division, defends the pre-authorization. He says the state doesn't deny Zyprexa to anyone who can't get help from the older medications, such as Thorazine and Haldol. And he argues that if cheaper drugs can do the job, it makes sense for patients to try them first.

The non-profit Kentucky Alliance for the Mentally Ill and other groups are blitzing the governor, lieutenant governor and other state officials with a letter-writing campaign calling for action. The alliance also hired a Virginia public relations consultant to help in what they say is the biggest effort since the early-1990s campaign to decriminalize mental illness in Kentucky.

Retail prices for a month's supply of Zyprexa can run $200 or more, compared with as little as $60 a month for Haldol or $30 for Thorazine.

"If a new drug for AIDS became available today it would be automatically approved for anyone who wanted to take it," said Sheriall Cunningham, president of the Kentucky Mental Health Association. "We feel the same way about schizophrenia."