Imagine choosing between 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 running out of your anti-anxiety medication and enduring 2 painful weeks before the pharmacy has approval to refill your prescription.
Maybe you don’t have to imagine those scenarios because you’re one of thousands of Illinois people already facing the harsh reality of the state’s new drug limits for Medicaid recipients.
This past summer, Gov. Quinn signed the Save Medicaid Access and Resources Together Act – “SMART” – restricting Medicaid patients to four prescriptions a month. Many patients rely on a combination of five or more medications to keep them healthy and avoid more costly care.
The law allows doctors to write more than four prescriptions for those who need it. They must first get approval through a process plagued with problems. Doctors report phone and fax lines to the approval system are constantly busy, leaving patients waiting for days or weeks without their medications. One provider called 22 times in one day and still didn’t get through.
The Community Behavioral Healthcare Association of Illinois has received more than 700 comments saying 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 stressful, unmanageable situations for families.
The SMART Act needs smart improvements before we start seeing catastrophic results. 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The Association will work across Illinois to have this drug limit repealed, and advocate for a more efficient, reliable medication management process. Our communities depend on it.
Note to readers – Jim Sarver is president and CEO of Sinnissippi Centers Inc., Dixon, and Frank Anselmo is the CEO of Community Behavioral Healthcare Association of Illinois, Springfield.