Another View Prior authorization for drugs to treat mental illness is a pubic safety problem

A bill currently pending before the N.H. Senate would keep in place a moratorium on the use of prior authorization requirements for medications used by community mental health centers to treat mental illness. HB 1680 will ensure that the most severely mentally ill individuals in our state do not experience delays or denials in getting the medications they need. It is supported by NAMI-NH, the N.H. Medical Society, the N.H. Hospital Association, and the N.H. Community Behavioral Health Association, and it unanimously passed the House Health and Human Services Committee and the full House of Representatives last month.

But the bill – HB 1680 - is now being vigorously opposed by both the managed care organizations (MCOs) that manage the state’s Medicaid program, and the Department of Health and Human Services.

As a police officer with 29 years of experience in law enforcement, I am very concerned that lifting this moratorium will be harmful not just to the people who are prescribed these drugs to manage their mental illness, but also to their families and the communities in which they live. I want to urge all 24 of our state senators to support HB 1680 and understand the impact I believe we will see on the public’s health and safety if they fail to pass this bill.

Since 2013, when the state’s Medicaid program went to a managed care model, the MCOs have made decisions about prescriptions using their own drug formularies and their own staff. These out of state companies decide whether mentally ill people in N.H. who have been able to function in the community for years with the help of medications can stay on those drugs, or if they must try a different, cheaper drug. The community mental health centers report that some adults taken off the drugs they have depended on for years have required increased services up to the point of inpatient hospitalization because, under the MCOs’ prior authorization requirements, they could not access the appropriate medication in a timely manner.

The prior authorization issue is a financial one for the MCOs and the state, but the harm to these very ill individuals’ lives and their families’ lives cannot be measured in terms of dollars. These are our most vulnerable citizens and we need to remember that the challenges they face in employment, education, housing and community life are tough enough.

Why would we want to add to their struggles an arbitrary requirement to change prescriptions that are already working for them because their medication may not be on an insurer’s formulary? The whole point of a formulary – which is the list of drugs the insurer or MCO has negotiated with the pharmaceutical companies - is to give the MCO the cheapest alternatives for paying for drugs.

When severely mentally ill people are taken off their medications, there are also costs to the local police, the courts and jails, as well as to state hospitals and hospital emergency rooms – costs which the MCOs are not responsible for. I have seen cases when people who are not on their medications have lost their jobs, been destructive to themselves and to others, have caused damage to property, have become homeless. All of this puts a completely unnecessary burden on a police department that is already challenged with a serious opioid crisis.

It is also inhumane. I will close by saying that delaying or denying necessary medications for the severely mentally ill is penny wise and pound foolish. Our Senate should support passage of HB 1680.

— David Mara is the interim chief of the Portsmouth Police Department.