Advocacy group says bill would reduce access to mental illness medication

SALT LAKE CITY — Almost 10 years ago to the day, Rick Frendt was diagnosed with schizophrenia.

It took such deep root, Frendt said, that he destroyed almost all his relationships and career prospects before his psychiatrist and family got him to agree to take medication.

"Had the shot not been available at the precise time of my family getting me to agree to it, I know I would not be here today," said the 31-year-old.

Frendt spoke Monday at a public meeting that was emotional and at times contentious, as health care providers, law enforcement officials and legislators debated a bill that would allow Medicaid to cover certain psychiatric drugs and not others.

Rep. Raymond Ward, R-Bountiful, said he's been working on HB18 for eight years, driven by the fact that Utah is one of a handful of states that has not added at least some anti-psychotic drugs to what's called a "preferred drug list."

Preferred drug lists are designed to encourage providers to prescribe certain drugs that are — theoretically — less expensive but equally effective.

Melissa Hansen, a Woods Cross resident, said she's concerned her children's medication could be excluded from the list.

Hansen's 8-year-old son has severe attention deficit hyperactivity disorder and oppositional defiant disorder. Her 11-year-old daughter has also been diagnosed with ADHD and a mood disorder.

It took many tries over many years to find the right medication for them, Hansen said.

At one point, her daughter was on a medication that had such bad side effects that she pulled out all her eyelashes at school, Hansen said.

But that medication — which had such horrific side effects for her daughter — worked well for her son.

"That's the problem with mental health medication," Hansen said. "One can work fantastic for one child … but not be a good fit for another child. That's why the freedom of choice in medication is so important."

Her son is intelligent and kind, she said. And her daughter is beautiful and tough.

Above all, they want to "be good," Hansen said.

"I just want to help my kids to be good, and if that requires medication, then I want them to be the best medication for their condition," Hansen said.

People at the House Health and Human Services committee meeting Monday traded testimonies and studies, with supporters saying putting psychotropic drugs on the list would generate significant cost savings and opponents arguing that restricting access would result in unintended costs.

Legislative fiscal analysts estimated the bill would result in roughly $12 million of savings every year — savings that should be reinvested in social services or possibly Medicaid expansion, according to Ward.

He said those cost savings come largely from the state's ability to negotiate with drug companies.

Right now, Ward argued, Utah's Medicaid program is paying more for the same anti-psychotic drugs than private insurers or other state Medicaid programs.

But Jamie Justice, the executive director of the Utah chapter of the National Alliance on Mental Illness, said the preferred drug list would steer providers toward cheaper drugs that aren't as effective.

For a population where no two patients react the same way to one drug, that could have disastrous consequences, Justice said.

She pointed to several studies showing that restricting access to mental health medications would result in more hospitalizations and incarcerations.

"The only reason I've entered into the cost argument is because it's what our legislators are focused on," Justice said. "What I'm thinking about is their pain and their suffering, and the years they've had to battle these illnesses. And we don't need any more barriers."

Ward said his bill contains several "important safeguards" that make his proposal different.

For one, patients would not be forced to give up a drug if it's already working well, he said. If a health care provider believes a patient should stay on a medication that isn't on the preferred drug list, they can apply for a waiver and Medicaid will still cover it, Ward said.

He added that the Utah Department of Health has an average turnaround time for those requests of one hour.

For people like Frendt who are concerned about needing access in the most urgent of situations, the bill also allows providers to give out an emergency supply of medication.

But Rep. Paul Ray, R-Clearfield, said doctors "don't really understand mental illness from the other side."

"That's been the complaint, the struggle with our family," Ray said. "Because our doc doesn't have a clue. To say, 'I'm a doctor, I get this, it's OK' — that's not true. We've struggled finding medications under the preferred drug list with our (private) insurance. We've almost lost family members to suicide."

He said the bill might cause more people to fall through the cracks due to delays or discontinuation of their medication.

Ward argued that the process for choosing which drugs get put on the preferred drug list is rigorous, overseen by a panel of experts from the University of Utah and reviewed by the state.

Those experts evaluate drugs based only on their efficacy and are not allowed to see the cost of the drugs when they make their recommendations, according to Ward.

And if certain drugs are shown to have unique advantages, they must be put on the preferred drug list, he said.

"We are one of the very few states left that doesn't avail ourselves of this tool," Ward said.

The committee voted to table the bill for discussion at a later time, with lawmakers citing the need to hear from the Utah Commission on Criminal and Juvenile Justice.

After the amount of time and money that lawmakers invested in criminal justice reform, Ray said, "we have one chance to get this right." Email: dchen@deseretnews.com Twitter: DaphneChen_