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Penny Smart, Pound Foolish: Stopping funding for Mental Illness Medication November 28, 2010

Posted by Crazy Mermaid in Health Insurance and Mental Illness, Healthcare, Medication, mental illness.
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2 comments

Today I went to the pharmacy to pick up my 30 day supply of prescriptions for my mental illness.  My prescriptions consists of Geodon, Lamictal and a few other drugs. My total bill for 30 days of medication was $1057 per month. Multiplying that out by the number of months in a year, I spend $12,684 for a year’s supply of medication.

Then there’s the psychiatrist visit. If – and this is a big if- I don’t have any major emergencies like hearing voices, I can get by with seeing him about every 4 weeks or so.  That’s about $250 a month.  Then there’s my therapist.  She runs $125 an hour. I see her twice a month. $250 (it used to be weekly until the bill got too expensive).   Between my therapist and my psychiatrist, I spend another $500 a month for their services.  Don’t get me wrong: they’re worth their weight in gold.

The grand total for a year of care is $18,684.  With a price tag like this, it’s easy to see why medication for mental illness is an easy target for a Legislature turning over every rock trying to find ways to cut their budget. But doing so would be penny-wise and pound-foolish.

People who are used to having their prescription drugs paid for by Medicaid, will no longer be eligible for those drugs if these budget cuts go into effect. So what will the net result of this change be?

A significant portion of people with severe mental illness are on disability. Surviving on less than $12,000 per month, they will no longer be able to afford their medications or therapy. Heck, they would have to spend more than what they make in a year on medication if their subsidies went away. Impossible.  They will have to go without.

What does that mean for society as a whole?  It means that we will have a significant percentage of the severely mentally ill off their medications.  Although having the State pay for drugs for the mentally ill appears to be for the benefit of the person with the mental illness, in fact this is a matter of public safety.

Unlike someone who needs medication to thin their blood, a person with a severe mental illness won’t die if the drug coverage is discontinued. They won’t bleed to death or go into a coma without the drugs. So it’s attractive to the cash-strapped Legislature to cut out prescription drug coverage for the mentally ill from their budget. At a cost of thousands of dollars per person, it seems a logical way to save money.

But I hope the Legislature wakes up to this fact before it’s too late: mentally ill people need their medication for public safety reasons. If they’re disabled, they won’t be able to afford their medication without subsidies from the Government. They’re essentially unemployable because of their debilitating illness. They have no reserve of funds, living on the edge of poverty because of their disability.  Without Government interference, there’s simply no room in their meager budget for medication.

The Legislature needs to understand that the medication for the mentally ill is needed as much as or perhaps even more than someone who takes drugs to thin their blood.  If the guy needing blood thinners goes off his medication, there’s a good chance that he will suffer severe symptoms, including the possibility of his death. That isn’t the public’s and the Legislature’s perception of drugs for mental illnesses.

In fact, the un-medicated mentally ill are going to be much more expensive than the medicated mentally ill. Take me, for example. Without my medication, I would be in my own world, disconnected from my family and friends, lost in my own mind. I would once again be that mermaid, disrobing in public.  Trees would talk to me. I would once again believe I had ESP. But the main problem is that without my medication I would become a danger to society.  Believing that zombies are after me, or that I’m being held hostage or numerous violent scenarios will cause me to strike out at whoever tries to subdue me.

Imagine what the world would be like if suddenly all the people with severe mental illnesses- bad enough to be on disability- went off their medication at the same time.  What if the people on antipsychotics stopped taking them after their “free” supply ran out?  All of those psychotic people concentrated in Washington State won’t go quietly off their meds. They need those drugs to prevent their return to a psychotic state.

Washington State has the fewest hospital beds per capita in the Nation, so it’s not like we’ll have any room for the mentally ill in the mental hospitals. If they can get in, mental hospitals cost around $3,000 per day. But  before they go there, they’ll pass through the doors of a “real” hospital- likely the understaffed, overcrowded, cash-strapped emergency room. Think of it: a person in a psychotic state in a room full of sick people.

If they commit a crime, which many are likely to do, they will swamp the legal system and the jails. Police taking on the task of dealing with this situation will short-change other areas of their responsibility.  If you think medication is expensive, think about how expensive incarceration is. The last figure I remember reading is about $50,000 per year.

And what about the mentally ill people who injure others? A paranoid schizophrenic without medication will not be a pretty sight. Won’t those injured “sane” people and their loved ones appreciate what a good job the Legislature did by saving all that money?

I hope that the legislature comes to its senses before cutting those drug benefits.  I hope they recognize it for what it would be: a public health crisis.

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$58,752 for 18 Days of Involuntary Committment to Mental Hospital August 14, 2010

Posted by Crazy Mermaid in Escalating Healthcare Costs, Health Insurance and Mental Illness, Involuntary Committment, Mental Hospital, mental illness.
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1 comment so far

$58,752. Take a good look at this number.  It’s the cost for 18 days of room and board (no additional services like medication and Dr. visits are included) at Fairfax, a private mental hospital in Kirkland, Washington.*, where I was involuntarily committed back in May 2008 to mid June 2008.  That breaks down to $3,900.20 per day for the first 10 days and $2,468.75 for the final 8 days.

At Eastern State Hospital  (WA), a comparative public facility, the average cost per day for a stay there is $524 per day.  My stay there (room and board ONLY) would have cost $9,432. At Western State Hospital  in Lakewood, Washington, also a public facility, the average cost per day is $438.  My cost for 18 days of room and board there would have been $7,884.   Fairfax, a private hospital, charged over six times as much for the identical service.  What’s wrong with this picture?

It gets even better. At these rates, if 25 patients pay $3,900 a day, Fairfax grosses $97,000 a day.  If the beds stay full for a year, Fairfax grosses $35 MILLION dollars.

My family and, by extension, I, had no say in whether I would be involuntarily committed, much less the location or cost of my commitment. The State of Washington made the determination that I would be involuntarily committed.  Because it was an emergency situation, forced on me, my family had no opportunity to explore the various facilities and then do a cost comparison.  Even if we had known the cost, we had no choice. Fairfax was the only mental health hospital in the State with a bed. The State of Washington was forcing me to be involuntarily committed (against my will).  I had to go somewhere, and Fairfax was the only place with a bed. That’s why I went there.  Fairfax had me over a barrel, with no other options.  They took advantage of the situation to make their stockholders a little richer.

Lest you think I was at Club Med, let me rid you of that misconception. The food was cafeteria-style, brought to us on trays stacked in a three foot high mobile metal tray rack.  Built in the 1960’s, the building has not undergone any visible major or minor remodeling since its inception.  As it is a private hospital, the public information disclosure required by the State hospitals is not required of it. My stay there was not in some kind of padded room.  It was in a plain old regular dorm room, similar to one you’d find at an old college.  Granted, the doors to the outside were locked 24/7, but the facility itself was run-down. Unlike Western and Eastern State Hospitals, there is no website data from Fairfax citing its daily cost.  It’s a private facility.

Oh yeah: one more thing.  Fairfax is owned by Psychiatric Solutions Inc. (PSI). Please join me in congratulating PSI for making Fortune Magazine’s list of Top 100 Fastest-Growing Companies:

FRANKLIN, Tenn., Aug 18, 2009 (BUSINESS WIRE) — For the fourth consecutive year, Psychiatric Solutions, Inc. (”PSI”) (NASDAQ: PSYS) has made Fortune magazine’s list of the Top 100 Fastest-Growing Companies. It is the only Tennessee company to make this year’s list, as it was in 2008 and 2006. https://www.psysolutions.com/facilities/news/fortune-magazine.html

PSI, which is the largest operator of psychiatric inpatient facilities in the country, ranked No. 98 on the list released by the magazine in August 2009, which considers factors such as revenue and earnings per share (EPS) growth rates. Last year, PSI ranked No. 64. In 2007 and 2006, it ranked No. 49 and No. 34, respectively.

How can they get away with this? Simple: There is more demand than supply for short-term mental health care facilities. Solution: build more short-term care facilities.  I think that everyone would agree that $35 Million builds quite a few new facilities.

* Taken from Fairfax’s invoices to my insurance company.

The Cost of Generic Drugs VS Name Brands: Lamictal June 9, 2010

Posted by Crazy Mermaid in Bipolar Disorder, Health Insurance and Mental Illness, Healthcare, Medication, mental illness, Mental Illness and Medication.
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5 comments

The Cost of Generic Drugs versus Name Brands:  Lamictal

Although first approved by the FDA for treatment of  epileptic seizures in December 1994, Lamictal wasn’t approved for maintenance treatment of Bipolar 1 Disorder until June 2003. The first drug since lithium that was approved for this use, it is also used “off-label” for treatment of schizoaffective disorder, Bipolar II Disorder, borderline personality disorder, and Post-Traumatic Stress Disorder.

I was started on Lamictal in the mental hospital to treat the symptoms of Bipolar I, but my supply of medication ran out about 1 week after I was discharged.  When I got my prescription filled for a 30 day supply of Lamictal, I was shocked beyond belief to learn that the cost for that one month supply of 300 mg  was in the neighborhood of $450, or $5,400  a year.

In July 2008, Teva Manufacturing began offering a generic form of Lamictal in the 150 mg doses that I require.  Previously, it only made 25 mg and 50 mg doses, so it wasn’t practical for me to take 12 pills at a time in order to get the required 300 mg dose. When Teva began making the 150 mg pills in July 2008, it became practical to take two of them to equal my 300 mg dose.  At that point, my insurance company insisted that I change from the name brand Lamictal to the generic lamotrigine.  The cost of my medication was reduced from $450 per month to about $150 per month for 300 mg, or about $1,800 per year- a substantial savings of $3,600 a year,  but still out of the realm of most people’s idea of a bargain.

Now, almost 2 years later, I’m paying $14 for a one month supply, or $168 for a year’s supply of yet another generic form of  lamotrigine, this one manufactured by Cadila (Zydus). This drug is available to me through a mail-order prescription drug company, Medco, which is part of our insurance package. So what happened?  How can a drug cost go from $5,400 per year to $168 per year within a two year period of time?

In one word: generics.

But are they safe?  Are the generic formulas the same as the name-brand formulas?

To answer that question, I went onto the Federal Drug Administration’s website http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm#Reference%20Listed%20Drug to learn how the generic assessment is done. In a nutshell, the generics are tested on people just like the original brand-name drugs were tested, though the number of people they were tested on isn’t as large.  In the end, the FDA decides whether the test results are good enough to grant the manufacturer of the generic form of the drug approval to sell his drug, and makes that determination available online to the general public. In the case of lamotrigine, each dose, by manufacturer, has been tested and approved by the FDA (see http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=077633&TABLE1=OB_Rx).

In the final analysis, it’s up to the patient to decide whether the generic brand works as well as the name brand, but according to the FDA, the active ingredients are the same.

Is $450 a month an appropriate amount of money to pay for a medication?  Is it appropriate that the cost of the same medication varied from $5,400 a year to $168 a year within a two year period of time?  Is it any wonder that our health care costs are out of control?