Letters to the Editor

To the editor:

Commissioner John Stephen's support of a preferred drug list for psychiatric patients (SB 383) overlooks some serious difficulties with such a program.

If enacted, the program would allow the state, in consultation with doctors, to create a list of psychiatric drugs doctors must use for their patients unless the doctors can offer an acceptable medical justification for using some other drug that is not on the preferred list.

The main problem is that, in psychiatry, there are no therapeutic equivalents. The same drugs will not have the same effects on two people, even if they have exactly the same symptoms.

In my own history, Zyprexa helped, Risperdal did nothing; Ativan helped, Klonopin did nothing; Depakote helped, and lithium caused serious side effects. Any of these pairs could be considered therapeutic equivalents. In practice, I would have to get sick before my doctor felt justified in asking the state's permission to write me a brand-name-only prescription.

Another problem is that changing medicines can cause a person with severe mental illness to go through a serious recurrence of symptoms that could lead to loss of a job, a hospitalization or even worse.

So if there must be a preferred drug list, it must also provide that people now taking something successfully will not be forced to change. State employees, who have had a preferred drug list for a couple of years now, have gotten sick when forced to switch to cheaper anti-depressants. Sick days, overtime to cover sick days, and lost productivity make this a questionable way to save money, and the suffering makes it an inhumane way to try to save money.

And these people's conditions are relatively mild compared to a disabled Medicaid recipient with severe persistent mental illness. There is another way to save money on psychiatric prescriptions that would help patients, not endanger them. The state could monitor and question doctors who prescribe higher than average doses for conditions other doctors manage with lower doses. The state could also question doctors who prescribe a lot of different drugs for a single patient.

In addition to saving money, this approach would help patients by cutting down on over-medicating and poly-pharmacy, both of which put patients at risk or force them to function below their potential.

Ken Braiterman
Plaistow, NH