EDITORIAL: Treating PTSD cases can hit a drug formulary wall

March 12--Many who have changed health insurance policies have encountered some kind of glitch with the insurers' drug formulary -- the list of medications that can be prescribed under the policy's coverage.

Switch insurers and a drug covered under one policy may not be covered under the new one. You can still keep taking the drug if it works for you and you can find a provider to prescribe it, but you'll be paying more or all of the cost out of pocket.

When the condition being treated is something like an allergy, the formulary gap is usually not much of a problem; several alternatives are available. But it's a big problem for a growing number of military veterans taking medications to treat post-traumatic stress disorder (PTSD).

No drugs have been specifically approved for treating PTSD, but doctors have had some success with anti-depressant, anti-anxiety or anti-psychotic drugs, as well as others for pain and sleep disorders.

Because PTSD affects individuals in different ways, and because sufferers' genetic makeup may play a factor, every case is a little different. Often it's a matter of trial and error -- determining what drugs, what combination and what dosages work for a particular person.

For military veterans, this can be a big deal. When personnel with PTSD are still on active duty, the Department of Defense's very broad drug formulary applies, allowing clinicians to prescribe just about any medication that has met federal regulatory approval. But when they separate from active duty, they fall under the Department of Veterans Affairs' much more limited formulary.

Unfortunately, that sometimes means that medications that were working to control the veterans' PTSD symptoms are no longer covered. They either have to start experimenting with a new drug regimen or pay the costs themselves.

Ideally, Defense and the VA would coordinate their formularies. But penny-pinching gets in the way: The main reason the VA's drug menu is so limited is to control costs. While the service member is on active duty -- thus of greater value to the Pentagon -- cost is not as much of a consideration.

Congress has been reluctant to allow changes in the VA's formulary. But at the very least, veterans diagnosed with PTSD while on active duty should be able to continue receiving coverage for medications that have proven to work for them.

That the compassionate and fair thing to do. Treating the wounds of war -- be they physical or psychological -- is a fundamental debt America owes its veterans.

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