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For many people living with a mental health condition, access to the full range of the most effective medical products is a crucial component of successful treatment and wellness. In combination with other services and supports, such products are often essential for people with mental health conditions to thrive in wellness.
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Medications in the same class for the treatment of mental health conditions are not necessarily interchangeable. Yet barriers exist preventing people from obtaining the medication most appropriate for them. For example,
- prior authorization requires the individual to obtain approval from the plan before the plan will reimburse the cost of the medication,
- step-therapy requires an individual to try a medication recommended by the plan and fail first before the clinician-recommended medication is reimbursed, and
- non-medical switching requires prior approval from the plan before an existing prescription can be renewed.
These practices are dangerous and can result in people experiencing an onset of serious symptoms with devastating results
- increased financial burden due to unanticipated medical costs,
- deterioration of overall health, and
- diminished quality of life.
In the most serious of circumstance these practices could lead to death by suicide when a successful treatment plan has been altered through delayed access to medication.
Can’t find a Prescriber?
Each person’s insurance coverage is unique, but there is one question that sums up the challenges of financial burden and timeliness of care: How difficult is it to get an appointment within a reasonable timeframe with a psychiatrist listed in your insurance network?
To better understand the patient and family experience in addressing these challenges, DBSA distributed a survey entitled “Seeking Care from ‘In-Network’ Psychiatrists”. The intent of the survey is to provide a forum for patients and their families to share their experience with insurance networks. Responses to survey questions are presented in our white paper listed below with the hope that policy-makers will understand the experience of patients and family members with insurance networks.