APA Wary of Florida Law
A recently enacted Florida law that is expected to reduce the number of drugs the state's Medicaid program will pay for “puts people with mental illness at serious risk,” according to the American Psychiatric Association. The APA expressed concern about the limited number of drugs allowed in each therapeutic category; although the association's press release said only the two most cost-effective drugs were allowed, Jonathan Burns, press secretary for the state's Agency for Health Care Administration, said two drugs was the minimum number permitted and that there was no maximum. The “most harmful aspect of the law is a requirement that–each year–a patient must first fail on the cheapest mandated medications before the patient is given access to the medication his or her physician believes is optimal, even where the patient has been successfully treated with the physician-chosen medication,” the APA noted. But Mr. Burns said that once a physician has gotten prior authorization to put a patient on one of the formulary drugs, “that's the medication the patient uses. We're not going to ask physicians to put patients back on medications that they've already tried and haven't worked for them.” He did acknowledge, however, that some drugs currently on the formulary will be eliminated and no patients will be “grandfathered in,” so that some patients may have to change medications. The new formulary, which allows the state to negotiate with drug manufacturers, is expected to save millions of dollars.
Drug Misuse Death Rates
Baltimore and Albuquerque had the highest death rates from drug misuse of 32 metropolitan areas surveyed, with more than 200 deaths per 1 million people, according to a Substance Abuse and Mental Health Services Administration report. Minneapolis-St. Paul and Buffalo, N.Y., had the lowest rates, at 53 and 56 deaths per million, respectively, according to data from SAMHSA's Drug Abuse Warning Network. “Amazingly, the vast majority of people who need but do not receive treatment for a serious drug or alcohol problem don't even recognize they have a problem,” SAMHSA Administrator Charles Curie said. “We must encourage those in need to enter and remain in treatment before it's too late, before they become a mortality statistic.”
The OxyContin Wars
The federal Drug Enforcement Administration's efforts to stop illegal use of the prescription painkiller OxyContin have “cast a chill over the doctor-patient candor necessary for successful treatment,” Ronald T. Libby, Ph.D., a political science professor at the University of North Florida, wrote in a policy analysis for the Cato Institute, a libertarian think tank. The DEA's campaign includes elevating OxyContin to the status of other schedule II substances and using “aggressive undercover investigation, asset forfeiture, and informers,” he notes. “By demonizing physicians as drug dealers and exaggerating the health risks of pain management, the federal government has made physicians scapegoats for the failed drug war,” Dr. Libby wrote. When asked for comment, a DEA spokeswoman referred to a recent statement by DEA Administrator Karen Tandy. “We employ a balanced approach that recognizes both the unquestioned need for responsible pain medication, and the possibility … of criminal drug trafficking,” Ms. Tandy said, noting that physicians “are an extremely small part of the problem.”
Medicare Mental Health Drugs
The Centers for Medicare and Medicaid Services is requiring all health plans serving Medicare patients to include all antidepressant and antipsychotic drugs on their formularies starting in 2006, when the new Medicare drug benefit takes effect. In a document released in early June, the agency noted that in earlier guidance on the Medicare drug plan, it stated that “a majority” of drugs in these categories–as well as anticonvulsants, anticancer drugs, immunosuppressants, and HIV/AIDS drugs–would have to be on plan formularies and that beneficiaries should have uninterrupted access to all drugs in that class. But in training sessions and in answering user calls, “CMS has consistently explained that this meant that access to 'all or substantially all' drugs in these specific categories needed to be addressed by plan formularies,” the document stated. “This is because the factors described in our formulary guidance indicated that interruption of therapy in these categories could cause significant negative outcomes to beneficiaries in a short time frame.”
The Chosen Profession
“Be a physician” is the most common career advice that Americans give young adults, according to a Gallup poll of 1,003 adults aged 18 years and older. Twenty percent of survey respondents recommended that young women become doctors, while 17% suggested medicine as a career for young men. By comparison, only 11% and 8% suggested that women and men choose careers in computers, respectively. Nursing continues to be viewed as a women's profession: 13% thought women should choose nursing, but that choice did not even make the top five careers for men. Medicine has always been cited as a top career choice for men, although the percentages have been rising steadily over the years for women, as more pursue careers as physicians. “These poll results offer great encouragement for a profession facing a diversity gap and a workforce deficit,” said Jordan Cohen, M.D., president of the Association of American Medical Colleges.