Psychiatr Q (2006) 77:329–334
Point–Counterpoint: The Importance of “Open Access”
to Psychotropics for our Patients
Alan D. Schmetzer, M.D. ·
John J. Wernert III, M.D., M.H.A.
Published online: 22 August 2006
Springer Science+Business Media, Inc. 2006
Abstract The opposing arguments regarding so-called “open access” to psychotropic
medicines for all physicians are outlined, with references. The reader is left to draw conclu-
sions from the discussion or to utilize the points in presentations to politicians, the media,
pharmacy and therapeutics committees, state Medicaid agencies, etc.
Keywords Open access
Chronic mental disorders
It should be no surprise that physicians wish to have some freedom in choosing treatment
options with their patients. Psychiatrists especially argue that effective care requires optimal
matching of patient needs with unique therapeutic characteristics, particularly when dis-
cussing medications. The belief that every medication and psychotherapy had its niche was
actually seldom questioned until the past two decades, during which we have seen a veritable
explosion of new medications, many of which are many times as expensive as their older
counterparts. This has caused Medicaid expenditures for each patient with schizophrenia
in one state system to go to an average of $15,000 per year . Over this same period of
time, “managed care” has penetrated many markets to the point that psychotherapies are also
routinely questioned due to their “expense” or seemingly open-ended nature.
In recent years, we have found ourselves arguing the merits, or lack thereof, for open
access in front of politicians, the media, and the general public on a regular basis. Some
pharmaceutical companies have made public relations experts available to local psychiatric
societies for seminars meant to assist our debating skills on this issue . In light of the
fact that not all physicians agree on this issue either, especially when the details of just
who should be allowed complete prescribing freedom within a given category of medicines,
A. D. Schmetzer, M.D. (
) · J. J. Wernert III, M.D., M.H.A.
Department of Psychiatry, Indiana University School of Medicine, 1111 W 10th St, Indianapolis,