Prevention/Care Management, 2005

National Alliance for the Mentally Ill

October 2004

Influenced by findings from AHRQ-funded research, the National Alliance for the Mentally Ill (NAMI) developed a 10-point policy to ensure access to effective medications for people with severe mental illnesses in State Medicaid programs.

AHRQ-funded studies conducted by Dr. Stephen Soumerai and colleagues demonstrated to Medicaid that while restrictions placed on use of conventional anti-psychotic drugs may have reduced the amount of spending on these medications, such policies have led to an increase in consequent costs of clinical services. Specifically, the research illustrated that when drug coverage caps were in effect for adult schizophrenic patients, the result was an increase in acute care (emergency mental health services, partial hospitalizations, and mental health clinic visits) and other medical interventions that exceeded the savings from the caps.

NAMI's Policy Research Institute's Access to Medications Task Force was created to examine the available evidence and provide policy guidance on the issue of access to medications to the NAMI Board, its grassroots advocates, and policymakers.

The AHRQ study findings were instrumental in the development of the 10-point statement in which NAMI supports State strategies that include, for example, support of the following:

• Research efforts by pharmaceutical companies to develop new medications, but opposes pricing practices that make these medications unaffordable.
• "Polypharmacy Education Programs" that are aimed at reducing the over-prescribing of medications as an alternative to restrictive cost-containment programs.
• The development of notification, grievance, and appeals procedures to protect Medicaid recipients with serious mental illness.

The NAMI policy also supports Federal strategies that include the following:

• An increase in the Federal Medical Assistance Percentage.
• System-wide health care reform to reduce fragmentation in the delivery of mental health services and to ensure access to the most effective treatments.
• Increased funding allocations to the National Institute for Mental Health to gain better insights on access to new medications and supports increased funding for research on evidence-based practices.

NAMI is the Nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. The organization has over 220,000 members and 1,200 state and local affiliates. NAMI's Policy Research Institute's mission is to drive national, state, and local debates on reforms and investments in the nation's mental illness delivery and financing system.

Impact Case Study Identifier: CP3 05-01
AHRQ-Sponsored Activity: Research
Topic(s): Prescription Drugs, Low Income
Scope: National

Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris C, Bollini P. Effects of limiting Medicaid drug reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. New England Journal of Medicine 1994:331(10):650-655. (HSO5947)

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