Kennedy Forum Publishes Consumer Guide to Drug Formularies

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Issue Brief Provides Overview to Improve Access to Behavioral Health Medications

The Kennedy Forum released its latest white paper, A Consumer Guide to Drug Formularies: Understanding the Fundamentals of Behavioral Health Medications. The Issue Brief serves as an educational resource highlighting the powerful influence formulary design has on prescription drug benefits and patient health outcomes – especially those with behavioral health conditions, including substance use disorders. The publication concludes with several key policy recommendations to improve the management of insurance and prescription benefits, a critical issue for patients, providers, payors, prescribers and other stakeholders.

In the nearly 10-year period since the Mental Health Parity and Addiction Equity Act became law, the insurance industry has made incremental improvements in the way it allocates resources for mental health services when compared to medical/surgical benefits. However, even with health coverage, formulary design provisions often limit or deny patients access to the life-saving medications that their doctors deem medically necessary.

“No patient should be denied access to life-saving medicine,” says former Congressman Patrick J. Kennedy (D-R.I.), founder of The Kennedy Forum. “But that is exactly what happens to far too many people living with mental illness. Our health system, and the management of pharmaceutical benefits, should aim to make people whole, not force them fight for the care and prescription benefits they need. It is time we have a National conversation about improving the management of this system for all parties involved.”

Common industry policies, including “fail-first” provisions, are often cited as a leading gateway to poor patient medication adherence issues. These policies often require a patient to try a cheaper or less effective medicine prior to receiving authorization for the brand or more effective medication. The delay of an effective drug regimen can lead to negative consequences, and in worse-case scenarios, could be fatal.

Other key areas addressed by the Consumer Guide include coverage restrictions, quantity limits, prior authorization requirements, and mail order protocols. The policy recommendations outlined in the Issue Brief include promoting greater public awareness of drug formularies, knowledge of drug coupon and assistance programs, greater consumer protections, regulatory enforcement, and legislative changes to improve the coordination of care. The goal is to help consumers and others better navigate and understand how to get the best medication at the most reasonable cost.

The drug formulary Issue Brief is the second in a series of white papers that The Kennedy Forum has released in 2017. In June, The Kennedy Forum released an Issue brief, Filing An Appeal Based On A Parity Violation, which showcased the unique challenges consumers face when reporting a parity violation.

Click here to view and download complimentary versions of The Kennedy Forum’s policy papers. For more information about The Kennedy Forum and other helpful resources addressing behavioral health and substance use disorders, please visit http://www.TheKennedyForum.org.

About The Kennedy Forum
Founded in 2013 by former Congressman Patrick J. Kennedy (D-R.I.), The Kennedy Forum focuses on advancing evidence-based practices, policies, and programming in behavioral health. This is achieved through promoting public discourse in health and addiction issues, ensuring equal access for patients living with mental health and/or substance use disorders; and advancing prevention and treatment throughout the entire continuum of the healthcare delivery system. The Kennedy Forum’s collaborative partnerships help to foster greater provider accountability, integration and coordination, cutting-edge technologies, and brain fitness and health. The nonprofit organization publishes frequent issue briefs and is a repository of other educational resources on behavioral health parity issues. To learn more about The Kennedy Forum’s efforts to eradicate the stigma often associated with behavioral health, or to access related materials visit http://www.thekennedyforum.org, http://www.paritytrack.org, and http://www.parityregistry.org.

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Tony Ellis
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