As you recall, the ADHS budget reduction last fiscal year required us to scale back the services we provide to folks who were receiving behavioral health services but don’t qualify for AHCCCS (called Non-Title XIX). We also needed to switch to a “generic formulary” for Non-Title XIX folks on July 1 (which saves about $7M/year). We had initially intended to implement the generic formulary on July 1, 2010, but as that date approached, it became clear that some individuals needed more time to ensure that patients could be safely transitioned, so we modified our guidance document to allow the transition of remaining members by October 1, 2010.
We also added one name brand medication called Risperidal Consta, a long-acting injectable antipsychotic medication, to the formulary. There are numerous class equivalent antipsychotic medications still on the formulary to choose from as an alternative to the remaining name brand med’s, including long-acting injectables like Haldol Decanoate and Prolixin Decanoate. (As an aside, our TXIX formulary is among the most robust in the nation).
We’ve also asked our Regional Behavioral Health Authorities (RBHA) & Providers to have their doctors and patients apply for the pharmaceutical Patient Assistance Program if they or their patient believe a brand name med that has no substitute and is not on the formulary. We developed tips for accessing brand name meds to help streamline the process. We have been getting feedback that many individuals have been successful getting on Patient Assistance Programs.
If the patient doesn’t qualify for a pharmacy Patient Assistance Program (usually because of income), we’ve asked the RBHAs to make sure the patient knows about the new Pre-existing Condition Insurance Plan, which they may be able to afford. We also encourage the RBHAs to help patients apply for a medication discount card so they can get medicine at a reduced rate. Also, doctors may be able to obtain samples from the pharmaceutical company and provide those to patients at their discretion.
We’ve been conservative in our financial modeling and projections to make sure we avoid the need to cap enrollment and wait list new members later in the fiscal year. We’ll continue to carefully examine our Non-Title XIX expenses as the first quarter progresses. We’d like to expand the formulary to include additional name brand meds if we can later in the fiscal year, but our top priority is to make sure we avoid an enrollment cap toward the end of the fiscal year.
