Greenlick Wants State, CCOs, NAMI to Strike Deal on Psychiatric Meds

Psychiatric medications are carved out of the purview of the CCOs, limiting their ability to fully integrate mental healthcare. The organizations have tried repeatedly to remove this restriction, and this year the state will require them to allow any patient to stay on their preferred medication.

Rep. Mitch Greenlick, D-Portland, has asked the Oregon Health Authority to negotiate with representatives from the National Alliance on Mental Illness if the state agency wishes to give more power to coordinated care organizations to manage psychiatric drugs.

State law has prohibited any restrictions on psychiatric drugs for about 15 years, and, since the formation of coordinated care organizations, these drugs have been “carved out” of their purview, and paid for by the state outside of CCO budgets.

The carve out has been one of many hurdles that have prevented CCOs from better integrating mental healthcare with physical healthcare.

Last week, the Health Authority introduced House Bill 2300, which would allow CCOs to manage psychiatric medications the same way they manage any other prescription drugs -- through a formulary that uses a cost-benefit analysis. A key provision would require CCOs to allow any members currently on psychiatric meds to continue with their same prescription.

Oregon Health Authority lobbyist Jeston Black said that the state spends $130 million on psychiatric medications each year, and HB 2300 would save the state $8.2 million by steering new patients away from higher-cost medications -- small but critical savings in a year where the state healthcare budget alone has a roughly $900 million deficit.

Black said that 77 percent of Oregon Health Plan members who receive psychiatric medications are abiding by the state’s preferred drug list voluntarily -- leaving just under a quarter of patients who seek a specific drug not on the list. Among non-psychiatric drugs, which are mandated to follow the preferred drug list, exceptions are currently granted to 5 percent of patients.

“The overall impact to current Oregon Health Plan members would be rather small,” Black said. “We’re trying to find an agreeable space.”

“We’re tasked with treating the whole body, including the mind,” said Courtney Johnston, a lobbyist for the Coalition for a Healthy Oregon, representing eight CCOs. “We are cramped in our efforts to serve these patients.”

The state and CCOs have tried several times to give local groups the power to manage medications, but have run into a wall of opposition each time from pharmaceutical lobbyists as well as patient advocates such as NAMI and Disability Rights Oregon.

“CCOs don’t coordinate care now. They’re trying to take on new business when they don’t do a good job now,” said Chris Bouneff, director of NAMI-Oregon. “What we’re talking about is restricting access.”

Bouneff said that putting patients on 16 different drug formularies, one for each CCO, would cause hardship and chaos as they juggle whether their preferred medications are available, particularly as Medicaid recipients move about the state. “These meds are unlike other classes of meds -- they are not interchangeable,” he said.

He said he wasn’t opposed to any drug management, however -- he preferred an algorithmic approach that will more precisely get a patient with the appropriate drug. NAMI tried to get a pilot program in central Oregon implemented in 2012, but lobbyists from PhRMA helped kill that effort.

“It is time to address this issue seriously,” said Greenlick, creating an opening for the parties to work together to find an agreement.

Reach Chris Gray at chris@thelundreport.org.

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