WNYT.com

'Provider prevails' battle with the Governor

Posted at: 02/04/2013 4:30 PM
Updated at: 02/04/2013 5:43 PM
By: Benita Zahn

"We're being penny wise and pound foolish," says Senator David Carlucci. "That for 9 point 3 million dollars, if someone doesn't get the right medication or multiple people don't get the right medication the costs could be far greater than 9 point 3 million dollars to all of us."


   Because improperly treated mental health patients can end up in jail, losing jobs requiring additional medical treatment says Senator David Carlucci  and this group of mental health advocates. So they're imploring the Governor to reconsider his effort to pull something called provider prevails - where the doctor makes the treatment decision for certain drugs used to treat patients with mental health disorders. Provider prevails were pulled in October 2011 and restored 21 days ago - only to face the chopping block in Governor Cuomo's proposed budget.

"I was on an atypical anti psychotic drug and doing very well" explains mental health patient and advocate, Lady Charmaine Day.

   Educated at Cornell and Columbia Universities, Lady Charmaine  was employed as head of a human resources division. When she lost her job she lost her health insurance - landing on Medicaid. The medication she took to treat her mental illness was denied .. A cheaper replacement didn't work.

"I ended up in a hospital for several months, " explains Lady Charmaine Day. "Insanity. That's not a choice anybody wants. If I could change to be sane I would. And it takes me on the right medication in order for that to happen."

     Many of the so called a-typical antipsychotic drugs being targeted by the governor either don't have a generic equivalent, these advocates explain, or if they do, because there are so few manufacturers of the drugs, the cost savings isn't great. And they remind the governor that finding the right drugs can take much trial and error, so to force a change can be disastrous - and requiring patients to fail first on cheaper meds exacts a terrible toll on the person.