DANNA MAUCH, PHD PRESIDENT AND CEO MASSACHUSETTS ASSOCIATION FOR MENTAL HEALTH STATE POLICY ROUNDTABLE MASSACHUSETTS WOMEN IN GOVERNMENT (WIG) STATE HOUSE 5 MAY 2016 Medical Continuity of Care in Behavioral Health

People of the Commonwealth in Need  There are over 275,000 individuals in Massachusetts living with chronic and disabling mental health conditions. (DSHS, 2000)  An estimated 67,000 children are affected by serious emotional conditions. (DHHS, 2000)  Every day, children and adults of the Commonwealth in acute distress from behavioral health conditions are backed up in Hospital Emergency Departments awaiting access to intensive outpatient and inpatient care.  People wait for 8 to 12 weeks for access to Outpatient Clinic appointments with Psychiatrists skilled in prescribing medications targeted to complex behavioral health conditions.

Medical Continuity of Care in Behavioral Health Parity in Health Insurance Benefits and Access to Care was a long and challenging fight  The Massachusetts Legislature passed a Mandated Mental Health Benefits Law in the 1980s and a Parity Law in  The US Congress passed the federal Mental Health Parity and Addiction Equity Act in  The US Congress passed the Affordable Care Act in  After years of struggle to pass these laws, “benefit management” initiatives make it more difficult to get the full benefit of these hard won rights to equal benefits and full access to mental health or addiction treatment provided on the same terms as other types of health care.

Medical Continuity of Care in Behavioral Health Risks to Continuity of Care  Benefit management initiatives include a variety of strategies designed to limit access or control cost associated with the use of health insurance benefits.  Children and adults with serious and disabling mental health conditions are among the people of the Commonwealth who have insurance benefits that cover their critically needed medications, but are at risk for an unplanned medication switch because of benefit management and formulary changes made by health insurers or pharmacy benefit managers.  In some cases, these changes may occur during the plan year, when people in need have no choice but to remain on the plan and cannot seek alternative coverage that includes their medications.

Medical Continuity of Care in Behavioral Health Risks to Continuity of Care  Finding the right medication for major depression, bipolar illness, schizoaffective disorder or schizophrenia may take months of trials with several medications, as few medications are effective with more than half of the target patient groups.  Not all drugs advertised as “equivalent” are equal to the task and some cause unanticipated effects, with decreased therapeutic effects or increased side effects.  Peer reviewed literature underscores the risks of increased emergency room visits, psychiatric hospitalization, homelessness and incarceration for people whose medication treatment is de-stabilized.

Medical Continuity of Care in Behavioral Health Risks to Continuity of Care  According to a recent study published by the American Psychiatric Association, psychiatric patients who stop taking their medications because of prescription drug coverage changes, utilization management, or copayment issues are 3.2 times more likely to be homeless. The same study also found that psychiatric patients who discontinue or temporarily stopped their medications are more than twice as likely to be incarcerated in prison or detained in jail. (Alter et al., 2009) Need Informed Approach to Ensuring Continuity

Medical Continuity of Care in Behavioral Health MAMH urges creation of the Patient Access and Safety Commission  The proposed Commission would study the impact of non- medical switching of prescription drugs.  The Commission would inform policy decisions about the most effective methods to bring knowledge and transparency to ensure that clinical considerations of patients are balanced with cost concerns of insurers.  The Commission would protect the most vulnerable individuals in the Commonwealth – those with complex treatment needs.

Medical Continuity of Care in Behavioral Health MAMH Thanks You for Your Concern  Senator Flanagan  Representative Benson  Senator Chandler  Representative Ferguson  Representative Kane

Medical Continuity of Care in Behavioral Health References  U.S. Public Health Service, Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda, (Washington, DC: Department of Health and Human Services, 2000).  McGuire, Thomas G., and John T. Montgomery. "Mandated mental health benefits in private health insurance." Journal of Health Politics, Policy and Law 7.2 (1982):  Alter, C.L., Crystal, S., Muszynski, I.S., Rae, D.S., Regier, D.A. Sanders, K.E., Stibec, M.R., West, J.C., & Wilk, J.E. (2009).Medicaid Prescription Drug Policies and Medication Access and Continuity: Findings from Ten States. Psychiatric Services, Volume 60 (Issue 5), pp