HD3 - A Study of Private Pay for Expensive Medications
Executive Summary: House Joint Resolution No. 175 called for a study of mechanisms for the delivery of expensive medications to patients in facilities operated by the Department of Mental Health, Mental Retardation and Substance Abuse Services. This study was stipulated by the desire to effectively respond to constituents who wanted improved access to clozapine, an antipsychotic medication (Clozaril, manufactured by Sandoz Pharmaceuticals), for consumers in state mental hospitals. The question of private payment for this expensive medication raised a number of clinical, legal, and ethical questions, some of which often arise as attempts are made to deliver new services in Virginia and other state public mental health systems. This is a summary of the findings and recommendations of the study. The study was focused in the DMHMRSAS Office of Medical Affairs. The department's "Clozapine Background Paper" (1990) was utilized as a reference and guide for the study. Discussions were held with other state agencies including the Department of Medical Assistance Services (DMAS), the Department of Social Services (DSS), and the Office of the Attorney General. Meetings were held with Chief Medical Officers of the DMHMRSAS inpatient facilities, and with staff members of a large number of Community Services Boards across the Commonwealth. A national meeting was hosted by DMHMRSAS for the purpose of gaining the insights and experiences of leaders and experts from across the country in public mental health, health economics, medical ethics, mental health advocacy, and psychopharmacology. Recommendations: 1. DMHMRSAS should continue to make clozapine available for the treatment of severely ill schizophrenic patients who have failed to respond adequately to standard antipsychotic drug treatment. 2. Priority for clozapine trials should continue to be based on lack of availability of other treatment options, patient and staff safety concerns, severity of illness, potential for rehabilitation and/or discharge, maximum potential for benefit and, importantly, patient preference. 3. Selection of patients for trials on clozapine should not be made based solely on the patient's ability to pay for the drug and the necessary laboratory and case management services. At the same time, patients should not be limited from contributing financially to their own care. 4. DMHMRSAS should continue to provide funding for clozapine for up to 150 patients at state mental health inpatient facilities. Appropriately selected residents of mental retardation training centers who fulfill criteria for clozapine trials can also be covered by this fund. 5. Each of these facilities will appoint a clozapine oversight committee responsible for selection of patients for clozapine trials and assessment of the success of these trials based upon objective measures. 6. DMHMRSAS should continue to utilize its recently appointed Pharmacy Committee, which has begun to provide guidance and oversight for pharmacy activities throughout the department. This committee, staffed and supported by the DMHMRSAS pharmacy consultant, will consider options to improve the quality of services provided while limiting the growth of the overall pharmacy budget. This committee will also oversee the further development of mechanisms to improve the delivery of clozapine to patients in community settings. 7. DMHMRSAS will begin a formal analysis of the cost effectiveness of clozapine. This study will provide a more detailed analysis of the impact of clozapine on facility census and cost projections, and community tenure of patients with schizophrenia. 8. The DMHMRSAS Office of Medical Affairs will continue to meet with staff of the Department of Medical Assistance Services and the Department of Social Services to ensure administrative case management for those patients that are in danger of returning to or remaining in state facilities as a result of lack of funding for clozapine. |
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