Proponents of bill cite need to control costs, limit overuse of antipsychotics
by Dave Ranney
The Senate Public Health and Welfare Committee on Wednesday heard testimony on a bill that would allow KanCare, the state’s privatized Medicaid program, to regulate mental health patients’ access to antipsychotic medications.
The committee’s chairwoman, Sen. Mary Pilcher-Cook, a Republican from Shawnee, set aside 20 minutes for the bill’s proponents, 20 minutes for its opponents and 20 minutes for questions.
The 15 opponents’ comments were each limited to about 90 seconds, while the five proponents were limited to four minutes.
“I’m sorry, but we have so many people who’ve signed up to testify that’s all the time we have,” said Sen. Pilcher-Cook, addressing a packed hearing room.
Since 2002, state law has guaranteed Medicaid patients access to whatever behavioral health drugs their physician or psychiatrist sees fit to prescribe.
Senate Bill 123 would change that, allowing the state to develop policies for deciding how, after July 1, mental health drugs would be prescribed. The three managed care organizations in KanCare would implement the policies.
According to Kansas Department of Health and Environment Acting Secretary Susan Mosier, tightening the prescription processes would improve beneficiaries’ health and likely save the state $8.3 million.
Mental health advocates oppose the measure, warning legislators that it would add administrative barriers to a treatment system that’s already challenging to navigate, send some high-need patients into crises and shift a sizable portion of the system’s costs onto hospitals and jails.
Mosier and Kansas Department for Aging and Disability Services Secretary Kari Bruffett assured committee members that their agencies are aware of the advocates’ concerns and that they have no intention of enacting policies that would put anyone in harm’s way.
Bruffett and Mosier called legislators’ attention to how, under current law, their agencies cannot stop physicians from putting young children on powerful antipsychotics meant for adults.
According to executives with the state’s managed care organizations:
• Amerigroup Kansas Plan has 6,800 children on its rolls who are under age 10 and taking at least one antipsychotic medication.
• United HealthCare has 600 patients who are taking attention deficit hyperactivity disorder drugs without a diagnosis of attention deficit hyperactivity disorder.
• Sunflower State Health Plan has 87 children age 2 or 3 who are taking at least one antipsychotic medication.
The companies’ representatives each expressed support for SB 123, saying their concern for their patients’ health outweighed their desire to lower costs.
The bill’s opponents doubted the companies’ assurances.
“The management of these medicines ultimately revolves largely around cost,” said Dr. Eric Atwood, a child psychiatrist with the Family Services and Guidance Center of Topeka. “This is a false economy, in my opinion, because what is saved on the medication level is only going to shift expense onto something else that is often more expensive.”
Atwood questioned the propriety of KDHE and KDADS officials asking legislators to repeal the current law without first explaining how mental health drugs would be prescribed under the new system.
“This is a very blunt instrument without a lot of – without any – forethought or planning on the specifics of how this would be managed,” he said.
Bruffett said KDADS hoped to begin crafting a specific plan next week.
Atwood also disputed Mosier’s claim that studies have shown that Kansas children are taking inordinate amounts of antipsychotics.
Kansas prescription rates, he said, have been found “not to deviate significantly from those in surrounding states.”
Terica Gatewood, who manages the pharmacy within Valeo Behavioral Health Care in Topeka, said she dreaded the prospects of giving prior authorization to the managed care organizations on which drugs are to be prescribed.
Today, she said, six-day waits on prior-authorization decisions for physical health drug prescriptions through KanCare are not unusual.
Similar delays for mental health drugs, Gatewood said, would be disastrous.
“Most of my patients will not wait for their (mental health) medications,” she said. “They don’t know what prior authorization is; they don’t understand why they can’t be treated. They don’t have transportation.”
Oftentimes, she said, they leave without their medication and do not return, and their conditions worsen.
Afterward, Sen. Jim Denning, a Republican from Overland Park, who is the former CEO of Discover Vision Centers, said that while he shared Bruffett and Mosier’s concerns that hundreds of children appear to be overmedicated, he also recognized the opponents’ worries.
“Pre-authorization, that’s my biggest concern with the bill,” he said. “As a patient, it’s annoying for me to have to wait, but I have a car and I can come back. But with these patients, if there’s a 24-hour or six-day breakdown, in my district, they’ll overwhelm the Rainbow crisis center first; then they’ll overwhelm the jail second.”
Denning said he’s likely to propose enacting policies that would make it clear to the managed care organizations “that if this pre-authorization thing were to blow up, there would be hell to pay.”
Sen. Laura Kelly, a Democrat from Topeka, said, “I have concerns on both sides. I’m hoping that from this (hearing), we can convene a group of proponents and opponents and really work toward a compromise that addresses the relevant issues.”
Rep. Kathy Wolfe Moore, a Democrat from Kansas City, Kan., who is the business director of the University of Kansas Hospital, attended the hearing.
“Before we get to the point where we’re going to rescind current policy, I think we ought to know what the new policy is and how it’s going to work,” Rep. Wolfe Moore said. “This makes no sense to me. This is a very serious issue that will have some very serious consequences if it’s not done exactly right.”
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