title: Access to care: clozapine in the public sector.
abstract: Clozapine holds great clinical promise for some chronic schizophrenic patients. However, limitations on access to the drug by the largest subgroup who need it, the indigent, are causing frustration for patients, their families, physicians, and public-sector mental health systems. The drug is available only through the manufacturer's proprietary monitoring system; many public-sector professionals and agencies feel that the system is overpriced, is unfairly exclusive, and has thus far kept the drug out of reach of most patients who need it. Arguments that patient improvement will lead to dollar savings in the long run seem overly optimistic. The ethical issue of access to treatment remains. The author discusses these and related issues and reports early experience from several public mental health systems.
authors.affiliation: Texas Department of Mental Health and Mental Retardation, Austin 78711.
authors.forename: W H
authors.initials: WH
authors.lastname: Reid
mesh_terms: D000380:Agranulocytosis / Q000139:chemically induced; D002908:Chronic Disease; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003984:Dibenzazepines / Q000627:therapeutic use*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008484:Medicaid / Q000191:economics; D008489:Medical Indigency / Q000191:economics*; D012307:Risk Factors; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D014481:United States
chemical_list: D003984:Dibenzazepines; D003024:Clozapine