NAMI Smarts
for Advocacy
Medication: Protecting
Choice
© NAMI, Inc. 2015
Agenda
1. Learn why telling your story about
medications is important
2. Hear tips for telling your story effectively
3. Listen to an example
4. Discover what makes a story “work”
5. Write your own story
6. Practice sharing your story
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Ground Rules
To get the most out of our time
together, please:
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•
Turn off electronic devices
•
Participate fully
•
Keep questions brief
•
Ask your doctor (not us ) if you
have questions about medications
© NAMI, Inc. 2015
Why Protect Choice?
NAMI cares because:
– Medication can be an important recovery tool
• Medication is often a key part of mental health
treatment (but not always)
– One size does not fit all
• Response to mental health medications varies
• When side effects cause problems, a different
medication may work better
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Warm-up Activity
How has medication helped
with your recovery?
What did it take to get the
right medication?
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Health plans
(Medicaid, Medicare, commercial
health insurance or other health plan)
should help people get
the right medication to
aid recovery
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Yet, health plans may
make it difficult
to get the right medication
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Health plans may
limit your choice
of covered medications
formulary or
preferred drug list (PDL)
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Decisions about a plan’s
formulary are often made
by a
Pharmacy and Therapeutics
(P&T) Committee
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And it gets more
complicated…
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Health plans may
put some medications
in a higher drug list “tier” and
charge higher
out-of-pocket costs
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…make some medications
“non-preferred” and
charge higher
out-of-pocket costs
or fail to cover
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…require prescribers to
request
“prior authorization”
for coverage of a medication
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…or require people to
try and fail
on one or more
medications before
approving another
(“step therapy”)
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Limited formularies, high tier
placement, non-preferred
status, prior authorization
and step therapy can
keep people from getting
the medication they need
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Not getting the right
medication may put people
at higher risk for
emergency room visits,
hospitalization and more…
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More than
one out of every 13
emergency department visits
involve a
mental illness¹
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Mood disorders were the
top reason
18-64 year olds were
admitted to a hospital
after an ED visit²…
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…and psychotic disorders
were the
fourth most common
reason³
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“A medication that works well for one
person with schizophrenia often
doesn’t work well for another.
Genetic variations are thought to
play a key role in this difference in
response. While patients search for
the right medications, their illnesses
may worsen.” The National Institute of Mental Health²
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© NAMI, Inc. 2015
Why tell your story?
Because the right medication
can make a big difference in
people’s recovery…
your story is proof
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Real stories can change
how medications are
covered by health
plans
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But, some stories are
more effective
than others
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We’ll start with some tips for
telling your story…
Tip #1
Keep it brief—stick to
the highlights
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Tip #2
Motivate with
hope and recovery
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Tip #3
Make an “ask”
that will help you get
(or keep getting) the
medication you need
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With our tips in mind, let’s get
started…
–Listen to the example
story and notice your
reactions
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Let’s look at what makes the
sample story work…
–Compare the sample
story with your seven steps
checklist
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– Write your own story
using your story practice
sheet
– Use your seven steps
checklist and sample
stories for help
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– Practice sharing your
story with a partner
– Give and receive
constructive feedback
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What was effective?
What did you learn?
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“Act as if what you do makes
a difference. It does.”
William James
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Your story can make a
difference…
it can help protect
choice of medications
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Who can you share your story with
to influence medication choices?
• Health plan P&T (Pharmacy &
Therapeutics) committees
• Health plan pharmacy directors
• State Medicaid agency
• State insurance agency
• Elected officials
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What made an impact
on you today?
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Thank you for your
participation!
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© NAMI, Inc. 2015
Authors
Angela Kimball, NAMI
Associate Director of Policy and Legal Affairs
[email protected]
Valerie Hunter, NAMI
Director of Organizational Learning
[email protected]
Sita Diehl, NAMI
Director of State Policy and Advocacy
[email protected]
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© NAMI, Inc. 2015