Collecting the Evidence for Medicaid and Other Insurance Providers
Medicaid – the largest health insurance provider for people who suffer the most from untreated mental illness – will need critical evidence, beyond FDA approval, to show that these medicines can be delivered safely and effectively, and to whom, in a real world setting before these systems will cover the medicines and the necessary care model that accompany them.
We are focused on collecting data on effectiveness or how the medicines can show results in the "real world." For all insurance (commercial, Medicaid and Medicare) to make PAT broadly available, the field needs to demonstrate how generalizable research findings are to people in settings outside of clinical studies. We are working to develop agreements on necessary and common data variables that will allow standardized data collection across a wide range of stakeholders in the field. The goal is to enable aggregation and comparison across the many pilots, projects and real world use cases to improve our knowledge about PAT delivery and outcomes – while creating the real-world evidence that Medicaid and other insurance providers will need to make access broadly available.
With our partners at UC Berkeley Collaborative for the Economics of Psychedelics, 1440 Foundation, Healing Advocacy Fund, and PSFC, we have developed a core set of variables based on expert articles and input from stakeholders representing academic researchers, clinicians and state policy advocates.
The next step in establishing the standard variable set is to engage a group of experts representing different stakeholder groups to develop consensus on the core variables related to PAT care delivery. The process will include sufficient participation to ensure field-wide buy-in and promote the use of the agreed upon variables
In addition, showing the safety and impact of the medicines will inform legislative initiatives, help shape the public narrative, and galvanize the general public's attitude and interest in PAT.
This logic model outlines key data needs and steps to secure Medicaid coverage for PAT, from pilot data to policy change. PMHA Alliance leads efforts in research, funding, and insurer alignment to expand access for marginalized communities.
To downlod our Medicaid data approach and roadmap click here.