by Dave Ranney, KHI News Service
An advisory committee charged with helping state officials design a system for regulating the use of prescription mental health drugs for Medicaid patients met for the first time Tuesday.
“This is going to be an evolving process,” said Dr. Vishal Adma, a committee member and president of the Kansas Psychiatric Society.
The nine-member committee spent nearly two hours discussing the pros and cons of “prior authorization” policies that would allow the three private insurance companies that manage KanCare, the state’s Medicaid program, to approve or disapprove mental health drug prescriptions.
Until this year, Kansas law specifically prohibited policies and regulations — such as preferred drug lists or prior authorization requirements — that would have restricted or impeded a physician’s ability to prescribe mental health drugs for Medicaid patients.
Legislators changed the law after Susan Mosier, secretary of the Kansas Department of Health and Environment, testified that prior authorization would address long-standing safety concerns and likely save $8 million in the fiscal year that began July 1.
Mental health advocates opposed the change, arguing it would add to the system’s administrative costs and delay medications for patients with severe and persistent mental illnesses.
At Tuesday’s meeting, KDHE officials said:
• 500 of the state’s 260,000 Medicaid patients under age 18 are taking two or more mental health drugs.
• 450 children age 4 to 6 are taking at least one antipsychotic drug.
• 3,400 children age 7 to 13 are taking at least one antipsychotic.
Much of the meeting was spent discussing KDHE-proposed criteria for imposing dosing limits and for allowing the KanCare insurance companies to review prescriptions for adults and children.
Three of the four psychiatrists on the committee assured the group that almost all of the children who’ve been prescribed antipsychotics are in the state’s foster care system, have a severe mental illness or both.
Many of these children, they said, have been prescribed one or more psychotropic drugs because all other treatment options have been exhausted and the drugs have proven to be beneficial.
“If a medication reduces a symptom by 20 percent, it’s considered successful,” said Dr. Taylor Porter, a psychiatrist and medical director at Valeo Behavioral Health Care in Topeka.
Porter said he resists prescribing multiple medications but when he does it’s because “not doing it would be worse.”
Porter, Adma and Dr. Charles “Chip” Millhuff, staff psychiatrist at Family Service and Guidance Center in Topeka, each said they would support reviews of cases involving patients taking three or more antipsychotics but asked that the review process not be overly time-consuming.
Millhuff said a KDHE proposal that would require psychiatrists to fill out multi-page forms or to personally explain their decisions to a managed care company’s physician would “add a tremendous amount of administrative work onto us.”
Each of the psychiatrists said having to spend more time on administrative tasks would result in less time with patients.
Dr. Bradley Grimage, a psychiatrist with the VA hospital in Topeka, was unable to attend the meeting.
Much of the discussion was hampered by a lack of data from KDHE about how patients have been affected by taking more than one psychotropic, which medications appear to be most overprescribed and which types of practices — public or private, rural or urban — appear to be doing the most overprescribing.
“It would be helpful to understand the depth of the problems we are talking about,” Adma said.
During the meeting, the 25 people in the audience were not provided copies of the KDHE proposals. Sara Belfry, a KDHE spokesperson, said the policies were in draft form and would be provided later when updated copies are available.
The committee’s next meeting is tentatively scheduled for Oct. 28.
In keeping with the new law, the advisory committee’s recommendations will be forwarded to the state-administered Drug Utilization Review Committee, which will vote to enact or reject the recommendations.
The advisory committee will have the option of amending and re-submitting any recommendations that the Drug Utilization Review Committee rejects.
Two of the nine advisory committee members work at facilities based in Kansas City, Kan. They are Dr. Vishal Adma, psychiatrist and medical director at KVC Hospitals, Kansas City, Kan.; and Karen Moeller, clinical associate professor, University of Kansas Hospital, Kansas City, Kan.
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