(8-30-17) The debate about patient consent that I’ve highlighted this week has spurred additional interest in the first meeting of the congressional mental health advisory committee scheduled for August 31, Thursday, here in Washington D.C.
I’ve received emails from readers who have asked if involuntary commitment laws will be discussed. That’s highly unlikely because involuntary commitment standards are set by each state – not the federal government – based on a “dangerous” criteria established by a U.S. Supreme Court ruling.
This first meeting will be about introductions of commission members and potential topics to be discussed in the future.
In preparation, I’ve been asking for suggestions about steps that can be taken to improve the federal system. Here are some of the ideas that have been shared with me.
Medication pre-authorization: a suggestion from Dr. Dinah Miller, c0-author of Committed: The Battle over Involuntary Psychiatric Care.
As you probably know, when a patient is prescribed a medication, they may go to the drug store to fill it, only to be told that it requires “pre-authorization.” The pharmacy may then contact the prescriber by sending a form that needs to be filled out, or the prescriber may need to call the insurance company’s pharmacy benefits manager (PBM) to negotiate for the patient to be approved for the medication, a process that often takes 20-30 minutes of uncompensated doctor time. Sometimes it’s just a hoop to jump through, often the PBM wants to know that the patient has failed other, cheaper, medications or that there is a specific diagnosis that requires this specific medications without any leeway to use medications “Off label” as we sometimes resort to. Usually the process is instituted for expensive medications, but not always: one psychiatrist recently mentioned that she spent 30 minutes getting authorization for a sleeping pill — she was not aware that a 90 day supply of the medication could be obtained at WalMart for $10, much less than the cost of her time.
