Iowa has a mental health crisis. Bipartisan state elected officials and policymakers have worked diligently to bolster Iowa’s mental health care infrastructure since 2011. Republican Gov. Kim Reynolds has signed multiple bills to increase services for complex needs and children. The Cedar Rapids’ mental health region is working hard to develop much-needed access centers to create solutions for patients with complex needs who do not need to be hospitalized.
Sheriffs will now be able to bring those needing a crisis evaluation, who are medically stable, into a center for evaluation, stabilization and treatment. This one-stop-shop is key to patients gaining access to the right services at the right time.
One challenge continues to be the increasing need and lack of availability to psychiatric services and prescribing physicians in Iowa, especially rural areas. Research shows that using a combination of talk therapy and psychiatric medications provides the best outcomes.
According to the National Center for Disease Prevention and Health Promotion, 90 percent of America’s annual health care expenditures, $3.3 trillion, cover people with mental health disorders and chronic health issues. Of that, $329 billion was spent on prescription drugs.
Republican Sen. Chuck Grassley, chairman of the Senate Finance Committee, is working on a bill — the Prescription Drug Pricing Reduction Act (PDPRA) of 2019 — of huge importance to Iowans. The bill would overhaul Medicare and Medicaid, particularly how price standards are set on brand-name drugs, including a provision by Sen. Ron Wyden (D-Ore.), to restrict drugmakers from raising prices higher than the rate of inflation, as The Gazette reported in July.
Grassley highlighted the bill’s Congressional Budget Office (CBO) analysis, determining it would save beneficiaries $27 billion in out-of-pocket costs, taxpayers $85 billion in Medicare costs over ten years, and trim the cost of Medicaid by $15 billion by clarifying how prices are calculated.
Perhaps the group most hurt by high prescription drug costs are people with mental health struggles. Research continues to show that poor mental health negatively impacts a person’s physical health and life expectancy. Iowans with heart disease, cancer and many other chronic physical illnesses have poorer outcomes when also battling a mental health disorder.
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Medical academics have been unable to determine which typically comes first — a mental health condition or a chronic health issue. But for those with mental health challenges, a 53 percent higher chance exists of developing cardiovascular disease than those not reporting mental health issues.
For those with mental health issues, access to prescription drugs is crucial to stability and success in their professional and personal lives. Following a doctor’s orders and taking medications in a timely manner is a matter of functioning or falling apart.When a person loses access to medications, it starts a vicious spiral downward that may include loss of a job, relationships, home — or even a life if not rectified quickly. Once a person loses the ability to work, it becomes even more difficult to obtain prescriptions — especially in rural areas.
A provision of another health care costs act, S.1895, which is expected to be combined with Sen Grassley’s bill before receiving a vote from the entire Senate, would negatively impact how those with mental health disorders and other serious illnesses access their medications. Among the bill’s 48 sections is Section 207, which is meant to ensure innovation in biologic drug development. Unfortunately, this measure would do the opposite. Biologic drugs are produced from living things. The RAND Corporation estimates biosimilars (variations on existing biologics by different companies) could save patients and the health care industry $54 billion over the next decade.
This provision would abandon requirements for transparent quality bench marks. U.S. Pharmacopeia (USP), a nonprofit organization founded in 1820, sets standards to ensure quality and consistency of drugs, as mandated by current law. These guidelines reassure patients, pharmacists and physicians that medicines actually contain ingredients promised on the label — at the accurate strength and purity. The standards are entwined in global commerce. More than 140 countries follow USP standards to regulate biologics.
This legislation would also greatly expand the scope — and later, the budget — of the Food and Drug Administration, which is already struggling to meet its obligations with a $3.1 billion budget. The House Energy and Commerce Committee recently launched an investigation into the FDA’s foreign drug inspection program after a series of recalls of drugs produced in India and China.
In contrast, USP is a self-funded, nonprofit that crowdsources the expertise of the private sector, former regulators and academic medical researchers. Other agencies use USP standards, including Customs and Border Protection, to stop counterfeit or shoddy drugs from entering the U.S. supply chain. Iowans rely on ingredients for these biologics — which treat diseases including breast cancer, rheumatoid arthritis and Crohn’s disease — from the developing world.
In 2016, Congress considered this provision in a similar bill but ultimately rejected it. The fate of the PDPRA remains uncertain due to Republican opposition in the Senate. Abandoning the misguided biologics provision would ease the final bill’s passage while preserving the free market system that patients.
• Renee Schulte is a former state representative from Cedar Rapids and owns Schulte Consulting, a health care policy firm.