If a non-Title XIX Arizona citizen with a serious mental illness (SMI) no longer had access to prescribed medications other than basic generics and suffered permanent neurological damage as a result? Would the state be liable if the citizen could not tolerate the side effects of generics, discontinued taking them and happened to inflict harm upon another person?

In a strongly worded letter to Arizona’s Governor, the CEOs of the American Psychiatric Association, the National Council for Community Behavioral Healthcare, Mental Health America and the National Alliance on Mental Illness argued that not only would the state be liable, but the reduction in benefits for non-Title XIX patients recently enacted by the legislature in response to the budget crisis would end up costing more than it saves because of increased emergency room use, hospitalizations, and potentially more people with untreated mental illness being incarcerated.

Whatever the legal and cost-shifting ramifications, this much is for certain: The generics-only formulary for people with severe and persistent mental illnesses is medically unsound. It will “…result in physicians and other licensed prescribers practicing non-evidence-based medicine, which is substandard…and inconsistent with treatment guidelines.” It’s not something anyone who knows the slightest thing about treating these illnesses would recommend.