Loose Screws Mental Health News

In the wake of the Newtown, CT shooting, NRA chief executive Wayne LaPierre called for a national registry of those who are mentally ill. According to the Washington Post, the federal government does not possess the constitutional authority “to require state agencies to report data.” All the federal government can do is either offer or withhold funding, as it did in the wake of the 2007 Virginia Tech Shooting when it provided additional funding for state governments that shared 90 percent of their mental health records. But it seems that 38 states already maintain an active database that “require or authorize the use of” mental health records during gun background checks. And the Gun Control Act of 1968 does not allow sales of firearms to people who have been institutionalized or considered to be mentally “defective.”

For the purpose of firearms sales, I support the idea of maintaining a database of people who have been institutionalized. This could prevent a person from being a harm to himself or to others. I speak as a person who has been institutionalized for being a harm to herself more than once. If I’d had access to a firearm, I wouldn’t be here right now. There may be many others who are in the same boat.


The New York Times reported on mental health coverage through insurance. In any given year, 26 percent of adults have a mental disorder, and 6 percent of adults have a mental illness that prevents them from functioning, according to the NIMH. In addition, 21 percent of teenagers between the ages of 13 and 18 undergo a “severe emotional disturbance.” But it seems as though 85 percent of employers offer some kind of mental health coverage through insurance, and 84 percent of employers with more than 500 employees allowed access to in-network and out-of-network mental health treatment. Beginning in 2014, insurance plans will be required to cover mental health disorders as part of President Obama’s Affordable Care Act.

The New York Times notes that many psychiatrists, however, don’t accept insurance:

Plenty of psychiatrists in private practice accept no insurance at all, though it is not clear how many; their professional organizations claim to have no recent or decent data on the percentage of people in private practice who take cash on the barrelhead, write people a receipt and send them off to their insurance company to request out-of-network reimbursement if they have any at all.

My psychiatrist does not accept insurance. He writes me a receipt, and I am to seek out-of-network reimbursement, a claim that has been repeatedly rejected by my insurance. The NYT is right on the money in this instance. But I am happy with my psychiatrist and would rather pay out of pocket for him without reimbursement than to find another psychiatrist who is in network.


According to the San Francisco Chronicle, California is ahead of every other state in covering mental health services with public money. But as always, there are critics who say California does not go far enough, even though in 2004, California voters approved Proposition 63 that funnels $1 billion annually for mental health services by taxing the state’s highest earners. But funding is being cut, not just in California but also nationally, according to NAMI.

Overall, California cut $768 million from its state mental health services outlay during the past three fiscal years, according to a November 2011 report from the National Alliance on Mental Illness. California’s 21 percent reduction in mental health funding over that period is the seventh-highest among all states.

Nationally, states cut more than $1.6 billion in general funds from their state mental health agency budgets for mental health services since 2009, according to the 2011 report by the National Alliance on Mental Illness.

I’m not sure what can be done to stop funding cuts of mental health services when state budgets are slashing services across the board.


And finally, according to NY1 News, New York City Mayor Bloomberg has announced an initiative to get mentally ill people out of jail and into treatment facilities. The mayor’s office estimates that 36 percent of inmates suffer from some kind of mental disorder. The city initiative will attempt to “reduce incarceration rates, improve jail safety, and lower crime.”

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Lamictal's generic equivalent, lamotrigine, has now hit the market

So much for Miss Up-on-Pharmaceuticals.

I’ve been paying so much attention to Pristiq that the very medication I take slipped out from right under my nose.

How did I find this out? It hit me where it hurt.

In the pockets, of course.

I went to CVS yesterday night for my Lamictal refill. Since I’ve been under my husband’s plan, we’ve been paying about $40 for the medication. So I nearly doubled over when the pharmacy cashier said $54.

WHAT?

I was in a bit of a foul mood about money anyway so the last thing I wanted to do was argue about the cost of my prescription that had jumped up by $14. (Which, in retrospect, I probably should have done because I could have saved $49 right there.)

I came home and made my husband’s day go from bad to worse. He flipped out and got on the phone with his insurance immediately. He said that the max he should pay on any medication is $50 so why was he paying $54 and why the cost rose so sharply.

“Well, sir, it’s because Lamictal has now gone generic and you’re paying the difference between the cost of the medication and the cost of the generic.”

Bob gets off the phone and goes straight to Google News to find out when Lamictal went generic.

Money & drugsAccording to MarketWatch.com, Teva Pharmaceuticals commenced shipment of lamotrigine tablets on July 22nd
. So instead of either the pharmacist asking me if I wanted a generic version or the insurance company letting us know a generic version would be available (it would have saved them money), we ended up paying $49 more than necessary. It appears that Teva’s generic is AB-rated, which means that it has similar strength, bioequivalence, and efficacy. Overall, it likely shouldn’t be a problem if I go from Lamictal to lamotrigine. At least I hope not. We’ll see.

Mood rating:
5

Wyeth Pushing Pristiq Hard

PristiqThe Wall Street Journal reports that Wyeth, desperate to make money off of its Effexor XR-knockoff, Pristiq, says it will slash the antidepressant at a 20% discount compared to Effexor’s price. The price slash, CNN money reports, is a result of less-than-impressive clinical trial data on Pristiq’s “safety and effectiveness.”

Wyeth SVP Joe Mahady told analysts that Pristiq will sell for a flat $3.41 per tablet for both mid- and high-dose, Dow Jones Newswires’ Peter Loftus reports.

Wyeth, apparently, has done this in the past. Back when it was known as American Home Products, the company slashed its price on Protonix, its heartburn drug, to compete with AstraZeneca’s Prilosec. The drug generated $1.9 billion in profits for Wyeth last year. CNN Money reports that Teva Pharmaceuticals and Sun Pharmaceuticals began selling the generic version of the drug and handily cut into Wyeth’s profits: the company reported a 4.6% decline in profit and a 66% drop in sales for the drug for the first-quarter. What will happen with Pristiq remains to be seen. I’m not sure that doctors in 2010 will want to dole out prescriptions for Pristiq when they can save patients—and insurance companies—money by prescribing what will then be known as venlafaxine. WSJ also notes:

A month’s supply of sertraline (Pfizer’s old hit Zoloft) or fluoxetine (Lilly’s Prozac) goes for 50 cents a day at drugstore.com.

$3.41 or $0.50 per tablet. It wouldn’t surprise me if some insurance companies choose to exclude Pristiq from its list of covered drugs. Regardless, Wyeth expects sales of the drug to exceed $1 billion in its first year.

The drug will hit the shelves in May.

Mental health parity bill

I haven’t posted anything on legislation that relates to mental health care so it’s about time I did.

On March 6, the House approved the Paul Wellstone Mental Health and Addiction Equity Act, a mental health parity bill that will require most medical insurance companies to provide better treatment for mental illnesses akin to what they do for physical illnesses. This is a significant move considering that insurers who cover mental health treatment can currently do one of two things: make patients pay for the bulk of the cost or place limits on treatment. The Senate also passed a similar bill in September 2007. Here’s what both pieces of legislation would do:

Both bills would outlaw health insurance practices that set lower
limits on treatment or higher co-payments for mental health services
than for other medical care.

Typical annual limits include 30 visits to a doctor or 30 days of
hospital care for treatment of a mental disorder. Such limits would no
longer be allowed if the insurer had no limits on treatment of
conditions like cancer, heart disease and diabetes.

As a result, the cost of group health insurance premiums likely will go up. However, the bills do not apply to businesses with 50 employees or less or individual insurance.

According to the NYTimes, President Bush initially endorsed mental health parity but came out opposing the current bill because it “would effectively mandate coverage of a broad range of diseases.” Technically, he’s right.

Under the bill, if an insurer chooses to provide mental health
coverage, it must “include benefits” for any mental health condition
listed in the latest edition of the Diagnostic and Statistical Manual
of Mental Disorders, published by the American Psychiatric Association.

The protections of the House bill apply to people who need treatment for alcohol and drug abuse, as well as mental illness.

Covering a broad range of conditions is a step forward, but I realize if group insurers are forced to pay for all conditions listed in the DSM, I can see why premiums would go up. It wouldn’t surprise me if costs increased significantly. No one likes to hear this but if people want better mental health coverage, they need to be willing to pay for it. For those who suffer with mental illnesses, it’s certainly worth the cost.

(By the way, only 47 Republicans joined the 221 Democrats in helping to pass the measure. It has nothing to do with the overall importance of the bill but it was a little annoyance that I had to throw in here. Grr.)

Loose Screws Mental Health News

Liz Spikol linked to this and I can’t believe I missed it: Poorer mental health for black Caribbeans.

“The longer Caribbean immigrants who are black stay in the United States, the poorer their mental health, according to a study.

Prior research has shown that black Caribbean immigrants differ from African-Americans in various measures of physical health, but little research has been done on differences in mental health.

‘What we found was that ethnicity matters a lot in the black population in the United States for mental health risk,’ [lead author David R.] Williams said.”

This is certainly a study that should yield interesting results. As a first-generation African-American with West Indian parents, I can definitely see the higher risks of mental health problems in my own family. Not only is it an ethnic problem, but it also is rooted in genetic causes. My maternal line has no history of mental illness (the DSM threw out homosexuality a while ago), but my paternal line has many cases of mental illness – almost all of them developed after immigrating to the U.S. From what I understand, my grandmother suffered from some kind of mental illness and out of her eight children, three of them developed mental illness, including my father.

I’m mainly interested to see what kind of effect this could have on first-, second-, and third-generation blacks of Caribbean ancestry and what correlations result from immigrant relatives who developed mental illnesses in the U.S.

Before leaving office, Gov. George Pataki signed a bill into law that requires commercial insurance policies to pay for mental health care just like care for physical illnesses. (Pataki has been slightly redeemed in the sight of a former New Yorker who suffered under his reign.)  Since this is news from Dec. 23, you might have to pay $4.99 to read the article, but as of Jan. 9, the article is still available for free. Read a few excerpts below:

“Most commercial policies already cover mental health treatment, which the governor said had helped allay his concerns about cost, and so do government programs like Medicare and Medicaid.

Business organizations – whose members pay for most health insurance – and insurance companies generally oppose these kinds of mandates. But they did not work against the mental health bill this year, after small employers were exempted and after coverage that would have mandated treatment for alcohol and drug addiction was taken out of the bill.

An employer with fewer than 50 workers could opt out, but the insurer would be required to offer a policy that covered mental illness. The law pledges that the state will develop a method to help small businesses pay for that coverage if they choose to buy it.

There were at least 17 other states that mandated some kind of mental health coverage, but not full parity with other health benefits.”

I'm glad that the state has offered to help small businesses pay for mental health coverage if employers choose to provide it. It would be difficult for a small business to pay for health insurance – let alone mental health! – for 50 employees or less. However, it's an important investment in employees that small businesses and large corporations can't afford to overlook.

As for treatment for substance abuse, the state is doing a major disservice to employees who struggle with these issues. More employees are likely to suffer from some kind of substance abuse problem and the lack of coverage for treatment is a step backwards. During my mental health treatment, I've noticed that mental health problems sometimes accompany substance abuse. If a patient can't obtain substance abuse coverage, then the entire problem isn't solved. I can only hope that an amendment mandating substance abuse coverage is added to the bill in the future.

The American Foundation for Suicide Prevention provides their take on the bill:

"The law requires insurance companies to cover 30 inpatient and 20 outpatient days of treatment for mental illness. Companies must fully cover "biologically-based mental illnesses" including major depression, obsessive compulsive disorder, anorexia and binge eating. Timothy's Law would also require coverage for children with attention deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms. The measure is expected to increase premiums about 3 percent and no more than 10 percent, while providing a much wider array of mental health services.

Timothy's Law took effect on New Year's Day and will last for three years. The Legislature will make a decision about continuing the law in 2009. New York is the 38th state to enact mental health parity."