Cuomo budget plan eyes mental health prescription costs

ALBANY -- Buried in Gov. Andrew M. Cuomo's proposed budget is a cost-cutting measure that would empower the state and health insurance companies to deny low-income mental patients the specific brand-name antipsychotic drugs their doctors prescribe, in favor of less expensive versions.

Some care providers worry that some of those patients could be dangerous without an effective drug or if they stop taking it. The proposal would cover antipsychotic drugs for patients suffering from an array of mental illnesses including schizophrenia, bipolar disorder, personality disorders and deep depression.

"The additional hoops we have to go through may mean their symptoms go on longer," said Dr. Anna Lamb, a primary care physician in Batavia and president of the New York State Osteopathic Medical Society.

Cuomo insists that eliminating the "prescriber prevails" power wielded by physicians will pose no public threat, noting that the state's preferred list of antipsychotic drugs includes 13 brand names.

The measure would save $9 million in state funds. It's part of Cuomo's $143 billion budget proposal, which also includes spending increases such as an extra $420 million in tax breaks for movie productions through 2019.

The state already requires less-expensive generics when they are proven to work as well as brand names, but in the antipsychotic drug class there are few generics. The New York conflict is between competing brand-name drugs, some of which cost less. If the cheaper drug fails, a patient could appeal for his or her preferred drug.

The Cuomo administration and the medical experts serving his Medicaid "redesign team" say each is effective for the poor and elderly patients served by the government health care system. And the antipsychotic drugs also are prescribed for less serious disorders, such as insomnia, dementia and mild depression.