Elimination of "Two Strikes" Policy for Schizophrenia Drugs Could Save Medi-Cal Program $17 Million Annually
SACRAMENTO, Calif.----May 9, 1997--On Monday, May 12th, the Senate Budget Subcommittee on Health will debate a policy which could save taxpayers $17 million annually and reduce the human toll of mental illness by allowing unrestricted access to expensive new drug therapies for schizophrenia. The Department of Health Services' Medi-Cal Program, in a misguided effort to contain costs, currently requires individuals with schizophrenia to use older, less effective, but cheaper medications before newer treatments can be tried.
The 1950s-era medications (Haldol, Prolixin) cost roughly $1,000 per year while the newer atypical antipsychotics (Clozaril, Risperdal, Zyprexa) cost approximately $2,700 per year. "Medi-Cal needs to admit that its efforts to control expenses cost more than they save," said Rusty Selix, executive director for the Mental Health Association in California. "Virtually every state in the nation has looked at the data and made these new breakthrough mental health drugs available as a first-line therapy." Calling the new generation of antipsychotic medications "a major breakthrough," Annette Tapper, a Los Angeles women with Schizophrenia will share her experiences with committee members. "I had to fight tooth and nail, even posing as my psychiatrist's Secretary and asking Eli Lilly to deliver free samples of Zyprexa to keep going," said Tapper. "This drug changed my life. I haven't had a psychotic break in three and a half years. But the state wouldn't cooperate. If it hadn't been for my constant fighting C and the willingness of my doctors to challenge the system C I would no doubt have had a psychotic breakdown and been back in a state mental hospital once again.
How much would that cost?" The proposed budget language is similar to that contained in AB 659 by Assemblyman Gary Miller (R-Diamond Bar) and Senator Richard Polanco (D-Los Angeles), legislation sponsored by the Mental Health Association in California which passed the Assembly Health Committee with unanimous bipartisan support on April 8, 1997. A recent study by the USC School of Pharmacy concludes that the average cost of treating schizophrenia is $19,000 per patient per year. Unrestricted access to the newer medications would result in a net savings to the Medi-Cal budget of $5,000 per patient per year, a 29 percent savings to the total Medi-Cal budget. That savings more than covers the additional $13 million cost of the medications to the pharmacy budget. The analysis also shows that older medications have such significant side effects and work so poorly that 56 percent of treated patients switch from their initial antipsychotic medication, and a majority of these do so only after a break in drug therapy.
Ten studies have proven that unrestricted use of atypical antipsychotics are cost-effective and actually reduce overall healthcare costs. For example, San Diego County saved $4,842 per patient per year after patients began taking Risperdal. California and Georgia are the only two states still restricting access to these new atypical antipsychotics. This June, Hawaii will make atypical antipsychotics available without prior authorization. Kentucky, which has the most restrictive formulary in the nation, made changes last year to make these medications more readily available.
Schizophrenia is the most severe mental illness, causing delusions, hallucinations, disorganized speech, diminished emotions and withdrawal. Only 10 percent of individuals with schizophrenia are able to return to work following treatment with the medications currently available on the state's drug formulary. Usage of the newer medications results in a two-fold increase (20 percent) of schizophrenia patients returning to the workplace. "These newer medications may cost more per pill, but the savings far outweigh the initial costs," said Selix. "These are recovery drugs, they allow twice as many sufferers from schizophrenia to return to the work force and thus eliminate state expenses for Medi-Cal and welfare completely."
CONTACT: Mental Health Association in California Rusty Selix, 916/557-1167
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