She can’t afford to take it now so she won’t be taking it. Fulce, 24 years old from Weir, lost her Medicaid coverage for prescriptions when she turned 19-years-old. The Affordable Care Act provided coverage again, so Fulce signed up for AmBetter. She was unable to pay the premiums after she submitted her 2019 earnings as a hairdresser. She was sometimes paying up to $100 for a month of Valium. She stopped taking the drug. Fulce received her prescriptions from her primary care doctor, but she believes that she should have a psychiatrist evaluate her. Fulce stated, “But I don’t have $400 to pay for a psychiatrist workup.” She said that she has been struggling since then. She said, “I’ll go three month doing well, then maybe three month downhill.” Four years ago, she took Klonopin and overdosed. She was admitted to St. Dominic’s Hospital in Jackson. Tandi Karol Hawthorne, a Choctaw County educator and mental health advocate, stated that many families don’t buy prescription drugs due to the high price. She said that her husband David was diagnosed with schizoaffective in 1996. They paid $1,000 per month for his medication. She said that they could not have afforded the medication without Medicare, a private plan, and extended family support. Magellan Health Service is a national leader for behavioral health care management. It found that mental health drugs account for about a quarter of all pharmacy spending by private insurers and about a third by public payers like Medicaid. The Centers for Medicaid & Medicare Services predict that this number will rise 60% in the next decade. Matt Westerfield (communication director for Medicaid), stated that Mississippi had approximately 77,000 Medicaid beneficiaries with behavioral health diagnoses in the state fiscal year 2019. This includes both children and infants. Three main diagnoses are schizophrenia and bipolar disorder. Westerfield stated that the vast majority, if not all, of those 77,000 would be taking some type of mental health medication. According to a study done by Mental Health America, relapse can be caused by not having regular access to medication. According to Joyce West (director of the American Psychiatric Research Network), “Sixty nine percent of patients who have difficulty accessing medication had adverse events compared with 40% of patients without access problems.” The studies showed that patients with access issues look first at their insurance companies for prescription coverage. Beth Reiss, a spokeswoman for Mississippi Insurance Department said that health insurance companies use lists in deciding which drugs they will and won’t cover. Blue Cross/Blue Shield of Mississippi, and United Healthcare didn’t respond to inquiries about how these lists are created or the prior authorization process. This is where doctors try to convince companies that they will cover drugs not on their approved list. Westerfield stated that Medicaid recipients shouldn’t be affected by high-priced drugs. He stated that beneficiaries of regular fee-for service Medicaid will have to pay a $3 copay for all drugs, regardless of whether they are prescribed. Children, pregnant women, and long-term care residents are exempted from this copay. Two of the managed Medicaid plans do not charge beneficiaries a copay for medication, while the third charges a $1 fee. However, there is a limit to how many prescriptions Medicaid patients may receive. If medication is required, those under 21 years old are eligible to receive more. “Pharmacists are a critical part of the treatment group” Bob Lomenick, who owns pharmacies in Oxford and Holly Springs that treat over 3,000 patients. He stated that many people live on fixed incomes and that insurance companies are beginning to recognize that restricting access can lead to long-term problems. Lomenick stated that “payers are discovering that patients who don’t follow their medication instructions costs the system much money.” Lomenick noted that Latuda (a mood stabilizer/anti-psychotic) costs him $41 per dose while Vyvance, which is a popular ADHD drug, costs him $10 per dose. “Those ADD drugs a lot these days–some justifiable, some not.” Terence H. Brown is a pharmacist at GAC Community Pharmacy, Canton. He said that many manufacturers cooperate with patient assistance programs such as RxAssist and RxHope. Teresa Parker, compliance director at Region 7 Community Counseling, West Point, said that connecting patients with patient assistance programs is part of their plan to help patients get their psychiatric medication. She said that approval used to take five days. She said that it now takes three months for approval. Some patients choose to take pills for their physical ailments rather than mental health medications due to delays and high costs. Fulce stated that if you depend on a fixed income, any additional medicine, even a $60, must come from somewhere. Fulce believes that more should be done to ensure that mental health patients such as her don’t slip through the cracks. “A person who has never experienced a serious mental illness is not equipped to understand what it’s like. It’s not about making it every day, but more like minute to minute.”