Should Patients with Schizophrenia Receive Free Medication?

A recent study from Harvard Medical School found that restrictive drug programs might cause schizophrenia patients to stop taking their meds. Nearly 80% of patients without antipsychotic medication will have a serious recurrence of their illness within a year.

The study focused on Medicare beneficiaries with schizophrenia in the state of Maine and a policy (step program) that required schizophrenia patients to use a Medicare-approved medication before they were allowed to be prescribed drugs not on the “approved” list. In comparison with patients in states with no such restriction, schizophrenia patients in Maine were 29% more likely to stop taking their meds.

This policy seems to be yet another example of bureaucratic mismanagement. It seems obvious that the savings accrued from forcing schizophrenic patients to take medication that they feel is ineffective in controlling their symptoms (and that they ultimately quit taking) would be far outweighed by the cost of treating schizophrenia patients for a serious reoccurrence of their illness, likely in a hospital or psychiatric ward setting.

Perhaps we would be further ahead monetarily to cover the entire cost of prescription drugs for patients who suffer from schizophrenia, making it more likely that they take their medications regularly, and preventing costly relapses.

We could test this theory by comparing schizophrenia patients and their reoccurrence rates in the U.S. against the same population in a country such as Canada, where schizophrenia patients are covered under free health care plans. If the null hypothesis was true, and there is no difference in the populations, my theory doesn’t hold much water.

However, given the fact that 1% of the population in the U.S. suffers from schizophrenia, which translates to approximately 3 million people, it may be worth testing the theory. Paying for all of their prescription drugs would cost a large sum of money. Then again, so does paying for repeated treatment for reoccurrences of their disease caused by failure to take their medications. At the very least, there should be no restrictions on medications that may be prescribed to them by their doctors, who can be assumed to know them best, as opposed to government employees who make such decisions about health care.

Reference

Soumerai, S.B., Zhang, F., Ross-Degnan, D., Ball, D.E., LeCates, R.F., Law, M.R., Hughes, T.E., Chapman, D., Adams, A.S. (2008). Use Of Atypical Antipsychotic Drugs For Schizophrenia In Maine Medicaid Following A Policy Change. Health Affairs, 27(3), w185-w195. DOI: 10.1377/hlthaff.27.3.w185