Recovery from mental illness requires access to a full array of mental health services and treatments. Comprehensive access is necessary so that treatment plans can be developed based on individual consumer needs and preferences, rather than the administrative policies of insurance companies or managed care plans. For many people with mental illness, access to newer and more effective medications is a crucial component of a successful treatment plan.

However, for the millions of Americans who rely on Medicaid for their physical and mental healthcare, there is a growing threat to that access. Responding to growing budget deficit projections and expenditures on prescription drugs within Medicaid, states have explored a number of proposals to restrict access to medications. These include establishing restrictive formularies; implementing new or expanded prior authorization requirements; and creating Pharmacy and Therapeutics (P&T) Committees, the advisory bodies that recommend which medications should be included in or excluded from a formulary.

Mental health stakeholders have a crucial role to play in educating policymakers and the general public about the importance of unrestricted access within the Medicaid and public mental health systems to the range of psychotropic medications. Through stakeholders’ efforts, more policymakers are becoming aware that medications play an important role in the treatment of mental illnesses, and that restrictions on access can actually lead to higher overall healthcare costs.

Restricting Access to Psychotropic Medications

Pharmacy Benefit Managers: Advocacy Toolkit

Penny-wise & Pound Foolish: Restricting Access to Psychotropic Medications *

Issue Briefs: Access to Medications

Access to Mental Health Care

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For additional information, please contact the Advocacy Resource Center at 1-800-969-NMHA (6642), Option 6.