New Survey Cites Formulary Restrictions, Prior Authorization and “Fail-First” Rules as Obstacles

National Council for Behavioral Health Access Survey Infographic

WASHINGTON, Nov. 6, 2014 /PRNewswire-USNewswire/ — A new study administered by the National Council for Behavioral Health and the National Alliance on Mental Illness (NAMI) and published in Psychiatric Services today found many common insurance and state Medicaid policies may negatively impact patient health and impose a major workload on psychiatrists that takes time away from patient care and other important duties.

More than 50 percent of psychiatrists surveyed practicing in community mental health centers pointed to formulary restrictions, prior authorization and step therapy protocols as the most frequent roadblocks to prescribing an optimal treatment regimen. Step therapy protocols are sometimes referred to as “fail first” policies, as they only allow psychiatrists to pursue different drug options after other treatments fail to help patients.

“Our research shows that many obstacles continue to limit mental health providers’ ability to effectively provide care,” says Dr. Ruth Shim, one of the study’s authors. “The next step is to take policy action to remove these barriers to increase access to and quality of care for individuals living with mental illnesses.”

These policies burden providers with additional bureaucracy, time which could otherwise be used treating patients. Three-quarters of psychiatrists spend more than 10 percent of their time on utilization management-related administrative tasks, with one in ten reporting they spend 40 percent or more of their time on such tasks.

Most importantly, the study found medication restriction policies directly impact patient wellness. Three-quarters of psychiatrists state that patients had trouble complying with medication plans, while 62 percent said patients experienced increased emergency department visits, hospitalizations, and increased health care costs.

Increasing medication options will provide better care and improve patient results according to those surveyed. Nearly 90 percent of psychiatrists agreed that multiple medication options are important in allowing them to find the best fit for patients based on potential side effects in relation to their condition.

“Mental health treatments are not one size fits all,” according to Linda Rosenberg, president and CEO of the National Council. “Choosing the right plan should be the decision of a patient and their doctor, not rigid health plan policies. Increasing options, reducing paperwork and restoring physician authority ultimately results in better patient care.”

“The survey confirms what individuals and families affected by mental illness know from direct experience,” said Mary Giliberti, NAMI’s executive director. “Having a choice of medication is critical for positive outcomes. Too much time is being spent on needless authorizations rather than treatment. Policy change is needed to empower individuals and their doctors to make the right choices based on personal needs and goals, rather than on lists and failures.”

The study was jointly funded by a grant from Sunovion, Takeda Pharmaceuticals, and Lundbeck, LLC to the National Council and NAMI. A poster based on this data was presented at the American Psychiatric Association’s Institute on Psychiatric Services conference in San Francisco October 31-November 1 and an overview of the survey’s results was published in the November issue of the American Psychiatric Association’s journal Psychiatric Services, available at

The National Council for Behavioral Health (National Council) is the unifying voice of America’s community mental health and addictions treatment organizations. Together with 2,200 member organizations, it serves more than eight million adults and children living with mental illnesses and addiction disorders. The organization is committed to ensuring all Americans have access to comprehensive, high-quality care that affords every opportunity for recovery and full participation in community life. The National Council pioneered Mental Health First Aid in the U.S. and has trained more than 250,000 individuals to connect youth and adults in need to mental health and addictions care in their communities. To learn more about the National Council, visit

The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.

Todd Post, 202.684.7457, x276

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SOURCE National Council for Behavioral Health

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