90-day prescriptions may save insurers but hurt some patients, Cleveland Clinic psychiatrist says

Prescribing 90-day supplies of medications has become standard practice across the country, but it poses serious risks to patients who struggle with mental health issues, Brian Barnett, MD, an inpatient psychiatrist at Cleveland Clinic, wrote in an opinion piece for The Wall Street Journal

Dr. Barnett said he often sees patients who are chronically suicidal, and they frequently are given 90-day supplies of medications to treat their mental health conditions. 

But intentional overdose is the most common method of attempting suicide in the U.S., and antidepressants are responsible for 45 percent of suicides involving prescription drugs, Dr. Barnett wrote. 

His patients often tell him their insurers won't cover smaller doses. 

Since 2008, insurers and pharmacy benefit managers have pushed 90-day prescriptions instead of the once-standard 30-day supply because it saves insurers money by decreasing dispensing fees. 

Physicians often have to call insurers directly to ask them to cover smaller quantities, but even then insurers often deny the requests, according to Dr. Barnett. 

In 2012, the American Psychiatric Association asked insurers to allow physicians to determine prescription quantities, but no change was made, Dr. Barnett wrote. 

Many states now allow pharmacists to change 30-day supplies to 90-day supplies at their discretion, without consulting the prescribing physician. Even if a physician writes "dispense as written" on the prescription, Dr. Barnett wrote that many pharmacists at large pharmacy chains ignore those instructions because they're under pressure from their employers to give out 90-day supplies. 

Dr. Barnett said that mental health is still an afterthought for too many and that "costs can be trimmed without putting patients' lives in jeopardy."

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