����������

���������� Note: Substitutions for medications that aren’t on a managed care plan’s formulary happen often in private and public insurance, but in the Veteran’s Affairs system and in facilities that serve a preponderance of people without insurance, Medicaid substitutions is a method employed by prescribers to save money. The harmful practice is not an anomaly, and has been recorded in hospitals and clinics outside of the VA system. The practice is particularly devastating for people with psychopharmacology needs who also have physical health problems, which can be exacerbated by inappropriate prescribing.

��

VA Clinic Substituted Mental Health Drugs to Save Money

Washington Post; Josh Hicks, 4/23/2015

��

A Department of Veterans Affairs medical center in West Virginia put patients at risk by substituting prescribed mental-health medications with older drugs to cut costs,��according to a federal investigation.

The practice, exposed by an agency whistleblower, violated VA policy and created��a “substantial and specific danger to public health and safety,” the department’s Office of Medical Inspector found.

The U.S. Office of Special Counsel, which investigates and prosecutes whistleblower cases, informed Congress and the White House��of the findings in a��.

“At a time when many veterans are grappling with mental-health issues, this VA facility was cutting corners on needed drug therapy to save money,” U.S. Special Counsel Carolyn Lerner said in a statement Wednesday. “We only know this was happening because an employee had the courage to blow the whistle on this dangerous practice.”

VA rules bar the agency from basing��drug restrictions on economics alone and require the agency to provide��specific medications when necessary for a patient’s��health needs.

��confirmed that a VA clinic in Beckley, W.Va., implemented a “blanket restriction” on administering two��antipsychotic drugs, aripiprazole and ziprasidone, to help meet its cost-saving goals for fiscal 2013.

The facility’s pharmacy committee, responsible for making such decisions, made the change��without a clinical determination about the possible health impacts, according to the Office of Special Counsel. The chair of the panel at the time was not a physician.

The Office of Medical Inspector recommended that the clinic determine whether the��drug substitutions affected patients’ health, in addition to disciplining��the pharmacy committee’s leadership and��appointing a physician to head the panel.

Lerner said the clinic��took “immediate and appropriate measures” to resolve the drug-substitution issue. But she added that the whistleblower has made claims of continued��wrongdoing may be occurring at the clinic.

The VA said it��has begun an investigation based on the findings and recommendations of the Office of Medical Inspector report.

“We will immediately take action where it is warranted to ensure the most current medical standards are strictly followed,” the department said in a statement. “We applaud the VA employee who contacted the OSC on this matter. Secretary McDonald has made clear that employees who step forward to raise concerns have a direct bearing on the veteran outcomes we deliver, and this is an example of why that is important.”

Lerner said she closed the case “conditionally,” pending a follow-up report to address��the allegations of continued wrongdoing. The analysis��is due to be completed by May 11.

��

��