Budget crunch spurs Va. to close pharmacy for mentally ill

By Tom Jackman
Washington Post Staff Writer
Friday, October 30, 2009

Virginia is eliminating its statewide pharmacy for the mentally ill, which obtained discounted drugs and distributed them through local mental health boards rather than commercial drugstores, as part of its effort to reduce spending in tough budget times.

The $13 million the state spends on medications for the mentally ill instead will be sent directly to the 40 Community Service Boards across Virginia, which are scrambling to find pharmacies that will sell them affordable medications. The boards are concerned about having enough money to pay for drugs for patients in the Medicare Part D plan, whose federal funding often expires in the middle of the year, forcing them to pay for drugs out of pocket. Previously, Virginia picked up that cost.

And mentally ill patients who can't get their medications -- or don't take them -- can become dangerous, winding up in jails or hospitals, where the cost to taxpayers is much higher. A recent study for the General Assembly found that 18 percent of those in the state's jails and prisons are mentally ill, a number that has steadily risen as psychiatric hospital beds have been eliminated.

About 11,000 people were receiving drugs through the Community Resource Pharmacy before 2006, when most moved to Medicare Part D. The pharmacy serves about 3,300 people a month but assists many more Medicare patients.

But since the boards learned last month of the plan to eliminate the state pharmacy, they have found that pharmacies such as Wal-Mart's might be able to match or beat the prices the statewide pharmacy was paying as part of a national consortium. And in Northern Virginia, the mental health boards are considering joining to negotiate the best price with commercial drugstores. But the future is unclear as the local boards delve into buying drugs.

"What happens if I run out of money?" asked Chuck Walsh, executive director of the local board that serves 10 counties on Virginia's Northern Neck and Middle Peninsula. "I always felt there was a good partnership with the state. We were all in it together. . . . But if the [state mental health] department doesn't have a stake, it's just us. . . . How are we going to advocate for" more funds? Walsh asked.

Eliminating the pharmacy will save Virginia $800,000 by cutting nine jobs and was done reluctantly by the state's Department of Behavioral Health and Developmental Services. The department was directed to reduce its central office budget by 15 percent, spokeswoman Meghan McGuire said, and if the pharmacy wasn't closed, money for the medications would have been subject to a 5 percent cut.

Still, mental health experts and patients are watching with concern as the pharmacy, which was widely acknowledged as well-run and saved Virginia millions of dollars annually, is shut down.

"There's no guarantee this is going to work," said Mira Signer, executive director of the National Alliance on Mental Illness in Virginia. "It's a budget decision, not a policy decision. And that's really unfortunate because you've got really vulnerable folks at the end of this. It's just going to be a matter of time before someone falls through the cracks."

The state pharmacy is scheduled to stop filling prescriptions Monday and close Jan. 1.

The Community Resource Pharmacy provides medications to people who were discharged or diverted from a state mental hospital and are unable to pay for their prescriptions. Officials said Virginia was the only state with such a program, and it participated in a Minnesota-based consortium of 47 states that negotiated discounts of 30 percent or more from drugmakers.

Because of its special status, the pharmacy was allowed to send drugs to the local Community Service Boards, which could then distribute and monitor the drugs as patients came to get them, rather than have the patients visit a drugstore. The ability for the boards to distribute the drugs will be lost. And because the pharmacy was efficiently run, recycling unused or unclaimed drugs to save millions annually, it was able to pay for drugs for Medicare Plan D patients who were facing out-of-pocket costs. That also will be lost.

But mental health professionals say they are accustomed to cutbacks and hurdles.

George Braunstein, executive director of the Fairfax-Falls Church board, said he has found that big pharmacies such as Wal-Mart and smaller ones are looking to pick up customers, have some indigent programs available and might put a pharmacist on site.

Ronald Allison, head of the Cumberland Mountain board, discovered that Wal-Mart had some drugs on its formulary for much less than the state pharmacy was paying. But he and others were concerned that adding drug procurement to their tasks would increase administrative costs.

"Our goal, and I think we'll achieve it here, is that no one should have their treatment affected by this change," Braunstein said.

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