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A medical diagnosis involving mental health comes with a distinct set of challenges. As a psychiatrist I can attest that most people, including other health professionals, have limited familiarity with mental health treatments and strategies. Treatment modalities, medications and even diagnosis all require careful assessment and collaboration with the individual being treated.
Treatment options not only have to follow guidelines for care, but also take into account the patient’s beliefs, adherence and safety considerations. Weighing these additional factors are part of our training as psychiatrists and the work we do every day.
Jasleen Chhatwal
What isn’t in the patient care plan? The interference in the doctor-patient relationship through the insurance protocol known as “step therapy.” This occurs when the insurance company denies coverage for necessary medication prescribed by the doctor, requiring the patient to try a different (often cheaper/older) medication, and show a failure to get better before they will cover the originally prescribed medication. This places an undue burden on the patient, their support system, and the physician. It slows the progression to health, keeping the person sicker longer.
The worst situation is when a patient stabilized on one medication during a hospitalization, gets denied coverage of that medication by insurance after leaving the hospital. Since each insurance company has its own list of preferred medications, there is no easy way to know what medication will be covered; making it a rude, damaging, and frightening surprise at the neighborhood outpatient pharmacy. For many patients, this is where they may get disillusioned and stop their efforts at treatment.
For others, the treating physician or their staff will then spend hours communicating with insurance representatives advocating for the effective treatment – sometimes to no avail, needing to abide by randomly chosen, non– evidence-based step therapy protocols. Through extra doctor visits, possible hospitalizations, and medications that do not work, the patient suffers.
We should be striving for better ways to improve the mental health of our community. There is current legislation, SB1270, that would simplify the process by making these step therapy protocols transparent and communication back from insurers more timely. This is one way that we can raise the standards of care for mental health treatment in Arizona.
As a physician and Arizonan, I deeply appreciate the hard work and leadership of Sen. Nancy Barto, R-Phoenix, who has introduced SB1270. This bill aims to put safeguards in place that will go a long way in reducing burdens that current protocols place on citizens of our community and their physicians. The bill has passed the Arizona Senate and it is now up to the Arizona House of Representatives and Governor Ducey to make it law. There is optimism within the health care community that those we have trusted to represent us will see the merits of passing SB1270 and vote a resounding ‘YES’ to health, safety, and protecting the patient-physician relationship.
Dr. Jasleen Chhatwal, MBBS, MD, is president of the Arizona Psychiatric Society.
