Guest Opinions

Health care costs: Patient's well-being should be foremost

Reading your doctor's writing should be the most difficult part of getting a prescription filled. For the thousands of people served by the National Alliance on Mental Illness serves each year, prescription medicines can make all the difference in their ability to live normal lives. Making sure they get the right medicines their doctors prescribed is an important part of that.

That isn't always as straightforward as it seems, even when people have health insurance.

Sometimes, in an effort to cut costs, insurance companies and others will change the prescription from a new brand name to an older, lower-cost, generic medicine. Sometimes they will do this without telling the patient.

Switching to a lower-cost medicine can be a good option to help reduce the costs of prescription medicines. However, for the people we serve, getting the right medicine is most important.

Keeping costs low is a big part of health care today, but we want to remind people that they need to make sure they are getting the medicines the doctor thinks is best for them.

Doctors, patients and others in health care should follow three principles: prescribing decisions should be made by doctors and their patients, patients should be notified of any changes and everyone should be aware of opportunities to cut costs.

The good news is that with the proper medicines, treatment of mental illness and other diseases is possible and there always is hope in new research that treatments will improve. During the past couple of decades, treatment programs for a wide range of mental illnesses have improved dramatically and there is hope on the horizon for others who suffer from mental illness. As treatment becomes more effective, it has become equally clear that treatments must be individualized, given the complexity of brain disorders.

The resulting challenge is that the patients we treat often need access to specific medicines. While the new medicines that are available make a difference, not every drug works for every person. Some suffer from side effects. Others find that there are drug interactions with other medicines they are taking. That's why putting these decisions in the hands of doctors and patients is so important. There is no cookie-cutter approach and as the number of treatments grows, the options for doctors and patients grows.

For those with mental illness, getting the wrong medicine can have serious -- even catastrophic -- consequences that can spiral.

While many insurance companies, pharmacists and others are familiar with these problems, the pressure to cut costs is rising and some switch patients to lower-cost medicines without realizing the consequences. Sometimes, this will be done without telling the patient.

Some insurance companies encourage doctors to try lower-cost medicines first. In some cases they require trying those medicines first. While that can make financial sense, it may not make medical sense.

Patients, however, can make sure this doesn't happen. Everyone taking prescription medicines should make sure they are getting the medicine that was prescribed. If you are unsure, call your doctor to make sure the prescription is correct.

We understand the need to find ways to reduce health care costs. The National Alliance on Mental Illness routinely receives requests for help to pay for medicines and we work with agencies, pharmaceutical research companies and privatecharities to help provide the assistance those with low incomes need. As we try to find the right approachthat will get patients the medicines they need at the lowest cost, there will be false starts and there will be times that the pendulum swings too far in one direction.

As we hear about the high cost of health care, we need to keep in mind the potential consequences of cutting costs without considering the patient. It is a consideration that we risk forgetting and as some health insurance companies work to cut their costs, the consequences will grow increasingly apparent, often for those least able to deal with them.

* Gordon Bopp is former president of the Washington state chapter National Alliance on Mental Illness. He lives in Richland.

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