Imagine that you must choose between taking a medication that controls your high cholesterol and heart problems, or taking a medication that keeps you from being readmitted to the hospital for a mental health condition. Or, imagine you run out of your anti-anxiety medication and have to endure two painful weeks before the pharmacy has the necessary approval to refill your prescription.
Maybe you don’t have to imagine these scenarios because you’re one of the thousands of people across Illinois who is already facing the harsh reality of the state’s new drug limits for Medicaid recipients.
This past summer, Governor Quinn signed the Save Medicaid Access and Resources Together Act—or the “SMART” Act—that restricts Medicaid patients to four prescriptions a month, despite the fact that many patients rely on a combination of five or more medications to keep them healthy and avoid more costly care.
While the law allows for doctors to write more than four prescriptions for those who need it, they must first get approval from the state through a process that is plagued with problems. Doctors report that the phone and fax lines to the approval system are constantly busy, leaving patients waiting for days or weeks without their medications. One provider we heard from called 22 times in one day and still did not get through.
The Community Behavioral Healthcare Association of Illinois has received over 700 comments from providers who say the number of people with mental illnesses being denied their medications will soon result in an increase of costly visits to emergency rooms, an upswing in incarceration rates, increased substance abuse cases, greater numbers of homelessness, and cause stressful, unmanageable situations for families. Those are consequences that impact us all.
The SMART Act needs smart improvements before we start seeing catastrophic results. While it’s always prudent to look at where we’re spending public money, complicating and restricting medications to an already vulnerable population will not only hurt the patient, but also the state’s long-term fiscal health.
The Community Behavioral Healthcare Association will be working with our colleagues across Illinois to have this drug limit repealed, and to advocate for a more efficient and reliable medication management process. Our communities depend on it.
Clete Winkelmann, President and CEO
Patrick Phelan, Vice President, Education and Community Based Programs [Patrick is a Board Member of the Community Behavioral Healthcare Association]
Children’s Home Association of Illinois, Peoria
Frank Anselmo, Chief Executive Officer
Community Behavioral Healthcare Association of Illinois, Springfield