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NAMI Smarts for Advocacy Medication: Protecting Choice
© NAMI, Inc. 2015
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Agenda Learn why telling your story about medications is important
Hear tips for telling your story effectively Listen to an example Discover what makes a story “work” Write your own story Practice sharing your story 2 © NAMI, Inc. 2015
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To get the most out of our time together, please:
Ground Rules To get the most out of our time together, please: Turn off electronic devices Participate fully Keep questions brief Ask your doctor (not us ) if you have questions about medications 3 © NAMI, Inc. 2015
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Why Protect Choice? NAMI cares because:
Medication can be an important recovery tool Medication is often a key part of mental health treatment (but not always) One size does not fit all Response to mental health medications varies When side effects cause problems, a different medication may work better 2 © NAMI, Inc. 2015
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Warm-up Activity How has medication helped with your recovery?
What did it take to get the right medication? 4 © NAMI, Inc. 2015
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Health plans (Medicaid, Medicare, commercial health insurance or other health plan) should help people get the right medication to aid recovery 5 © NAMI, Inc. 2015
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Yet, health plans may make it difficult to get the right medication
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Health plans may limit your choice of covered medications
formulary or preferred drug list (PDL) 7 © NAMI, Inc. 2015
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Decisions about a plan’s formulary are often made by a Pharmacy and Therapeutics (P&T) Committee
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And it gets more complicated…
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charge higher out-of-pocket costs
Health plans may put some medications in a higher drug list “tier” and charge higher out-of-pocket costs 10 © NAMI, Inc. 2015
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charge higher out-of-pocket costs or fail to cover
…make some medications “non-preferred” and charge higher out-of-pocket costs or fail to cover 11 © NAMI, Inc. 2015
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…require prescribers to request “prior authorization” for coverage of a medication
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…or require people to try and fail on one or more medications before approving another (“step therapy”) 13 © NAMI, Inc. 2015
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Limited formularies, high tier placement, non-preferred status, prior authorization and step therapy can keep people from getting the medication they need 14 © NAMI, Inc. 2015
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Not getting the right medication may put people at higher risk for emergency room visits, hospitalization and more… 15 © NAMI, Inc. 2015
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emergency department visits involve a mental illness¹
More than one out of every 13 emergency department visits involve a mental illness¹ 1. Statistical Brief #92, Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, Healthcare Cost and Utilization Project (HCUP). June Agency for Healthcare Research and Quality, Rockville, MD. Accessible at 16 © NAMI, Inc. 2015
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Mood disorders were the top reason 18-64 year olds were admitted to a hospital after an ED visit²…
2. Statistical Brief #174, Overview of Emergency Department Visits in the United States, Healthcare Cost and Utilization Project (HCUP). June Agency for Healthcare Research and Quality, Rockville, MD. Accessible at 17
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…and psychotic disorders were the fourth most common reason³
3. Statistical Brief #174, Overview of Emergency Department Visits in the United States, Healthcare Cost and Utilization Project (HCUP). June Agency for Healthcare Research and Quality, Rockville, MD. Accessible at 18 © NAMI, Inc. 2015
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“A medication that works well for one person with schizophrenia often doesn’t work well for another. Genetic variations are thought to play a key role in this difference in response. While patients search for the right medications, their illnesses may worsen.” The National Institute of Mental Health² National Institute of Mental Health, Science Update, Ethnicity Predicts How Gene Variations Affect Response to Schizophrenia Medications, January 02, Accessible on the Web at 19 © NAMI, Inc. 2015
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Why tell your story? your story is proof
Because the right medication can make a big difference in people’s recovery… your story is proof 20 © NAMI, Inc. 2015
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Real stories can change how medications are covered by health plans
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But, some stories are more effective than others
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Keep it brief—stick to the highlights
We’ll start with some tips for telling your story… Tip #1 Keep it brief—stick to the highlights 23 © NAMI, Inc. 2015
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Motivate with hope and recovery
Tip #2 Motivate with hope and recovery 24 © NAMI, Inc. 2015
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that will help you get (or keep getting) the medication you need
Tip #3 Make an “ask” that will help you get (or keep getting) the medication you need 25 © NAMI, Inc. 2015
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Listen to the example story and notice your reactions
With our tips in mind, let’s get started… Listen to the example story and notice your reactions 26 © NAMI, Inc. 2015
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Compare the sample story with your seven steps checklist
Let’s look at what makes the sample story work… Compare the sample story with your seven steps checklist 27 © NAMI, Inc. 2015
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Write your own story using your story practice sheet
Use your seven steps checklist and sample stories for help 28 © NAMI, Inc. 2015
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Practice sharing your story with a partner
Give and receive constructive feedback 29 © NAMI, Inc. 2015
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What was effective? What did you learn?
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“Act as if what you do makes a difference. It does.”
William James 31 © NAMI, Inc. 2015
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it can help protect choice of medications
Your story can make a difference… it can help protect choice of medications 32 © NAMI, Inc. 2015
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Who can you share your story with to influence medication choices?
Health plan P&T (Pharmacy & Therapeutics) committees Health plan pharmacy directors State Medicaid agency State insurance agency Elected officials 33 © NAMI, Inc. 2015
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What made an impact on you today?
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Thank you for your participation!
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Authors Angela Kimball, NAMI Valerie Hunter, NAMI Sita Diehl, NAMI
Associate Director of Policy and Legal Affairs Valerie Hunter, NAMI Director of Organizational Learning Sita Diehl, NAMI Director of State Policy and Advocacy 36 © NAMI, Inc. 2015
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