Wonder Drugs Come with Hitch: Many Can't Pay Income Often Precludes Medicaid

By Roger Signor Post-Dispatch Science-Medicine Editor | St Louis Post-Dispatch (MO), December 27, 1994 | Go to article overview

Wonder Drugs Come with Hitch: Many Can't Pay Income Often Precludes Medicaid


Roger Signor Post-Dispatch Science-Medicine Editor, St Louis Post-Dispatch (MO)


Last May, Audrey F. Jones of St. Ann felt disoriented and suspicious, and she shook constantly.

Doctors had prescribed an old standby drug, prolixin, for her illness, schizophrenia. But the drug made her tongue move involuntarily, and she stopped taking it.

In May, her psychiatrist gave her risperidone, a new drug. It is one of several psychiatric medicines developed in recent years to reduce both symptoms of illness and side effects from the drugs themselves.

Jones, 48, became a new person after only two months on risperidone, her doctor says. "She's pleasant, converses easily and dresses well," said Dr. Ronald L. Beach of the state-funded Great Rivers Mental Health Center of St. Louis County. But there was one hitch: risperidone costs $2,500 a year. On a small fixed pension and disability insurance, Jones couldn't afford it.

Like thousands of other St. Louis-area residents, her income pays the rent and food bills. Many people cannot afford drugs that cost thousands of dollars a year; but their income is just enough to disqualify them for Medicaid, the state-federal program that pays medical bills for the poor.

In the long run, the newer drugs prevent even costlier rehospitalizations and save the taxpayers several million dollars, said Dr. Joseph J. Parks, deputy director of psychiatry for the Missouri Department of Mental Health.

Patients on new drugs usually keep taking them because they do not cause serious side effects. One study showed that 40 percent of patients on older antipsychotic drugs stopped taking them; but only 14 percent of those on risperidone in the study stopped taking that drug, Parks says.

To help people like Jones, the Legislature allocated an extra $800,000 last year to the Department of Mental Health.

Jones' symptoms were serious enough for her to benefit from the emergency fund. But many other patients with less severe symptoms were left out because there wasn't enough money to go around.

Rationing Medicine

As a result of budget shortfalls, the department sets difficult priorities - treating the sickest patients, say top officials of the agency.

"With that special allocation, we put 100 more patients on risperidone and 400 other patients suffering from depression on new antidepressants that have negligible side effects," says Parks.

But the medicine fund is nearly depleted. Early in January, the department will seek another $1.5 million to buy medicine for 400 patients with symptoms like Jones' and 1,000 patients suffering from severe depression, Parks said.

The need for treatment and new medicines is great, doctors say. For the fiscal year that ended June 30, the state's mental-health facilities examined and diagnosed:

19,000 patients with psychotic illnesses, chiefly schizophrenia.

40,000 with major depression and related disorders.

Not all of them return for treatment. But those who are treated usually have the most serious symptoms, Parks says.

An additional 314,000 residents of Missouri could benefit from the department's services.

But if all sought care, there wouldn't be enough staff or facilities to give them adequate treatment, he says.

A Major Issue

If everyone who needed psychiatric care went to state facilities at the same time, the cost for medicines alone would be tremendous, Parks said.

New antidepressants such as sertraline cost $800 a year, and the antipsychotics can cost up to $10,000 a year.

Older drugs for the same illnesses may cost only $400 a year - but their total cost is high because of the thousands who take them. Often, old drugs work as well as new drugs. …

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