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Pharmaco-Economics and Mental Health Policy: A Family Perspective


Families of persons with severe mental illnesses such as schizophrenia, bipolar disorder and other persistent and disabling disorders are especially concerned with the role pharmaceuticals play in the health economy. In the US most severely mentally ill people find that their illnesses are poorly covered by insurance. Policies are limited in both length and scope of coverage when compared to coverage for other medical illnesses. This discrimination is evident in both public and private insurance and results in poverty and dependency for nearly all persons with severe psychiatric disorders. On a policy level the US health economy is actually a two tiered system, with access based upon income. The neediest, sickest and most at risk for disability are the most poorly served, due to the stigma and discrimination that are at the heart of denial of equitable health insurance. Access to medically necessary treatments is frequently limited. With the introduction of new psychiatric medications, the cruelty of our two-tiered system has become clear. Due to the extremely high price, only a small fraction of the persons who could benefit from clozapine for example, are able to receive it. State formularies generally restrict access based upon budget constraints. In all states the de factor policy is that cost, not clinical need drives the selection of new medication to be offered to public patients. The practical effect of all this is that families of persons with schizophrenia, who have been vigorous and effective advocates of biomedical research, are forced to pay out of their own pockets for newer medications. Not surprisingly, this situation creates anger and despair. Why are drugs so expensive? Why is the US health economy unable to support subsidy for indigent patients? Why are costs 20% to 50% lower in Europe and South America? NAMI members tell me that the excitement of new drug development is tempered by the realization that the most seriously ill may never receive the benefits. And as we embark upon on massive systemic reform of our health system, the discrimination continues. One parent stated in frustration: “It's like being a child standing with your nose pressed to the glass at the candy counter. You know very well what you want, but you just cannot get it.”

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Flyn, L., Johnson, D. Pharmaco-Economics and Mental Health Policy: A Family Perspective. Neuropsychopharmacol 11, 259 (1994).

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