The Daily Caller

The Daily Caller
Marilyn Tavenner, administrator of the Centers for  Medicare & Medicaid Services (CMS), testifies before a House Ways and Means Committee hearing on "Affordable Care Act Implementation on Capitol Hill in Washington, October 29, 2013. Tavenner apologized to the public on Tuesday for problems that have made it difficult for people to enroll online for subsidized health insurance. REUTERS/Yuri Gripas (UNITED STATES - Tags: POLITICS HEALTH) - RTX14SQC Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), testifies before a House Ways and Means Committee hearing on "Affordable Care Act Implementation on Capitol Hill in Washington, October 29, 2013. Tavenner apologized to the public on Tuesday for problems that have made it difficult for people to enroll online for subsidized health insurance. REUTERS/Yuri Gripas (UNITED STATES - Tags: POLITICS HEALTH) - RTX14SQC  

CMS tries to strip patient safeguards

Photo of Charles Ingoglia
Charles Ingoglia
Senior Vice President, National Council for Behavioral Health

One in five American seniors suffers from depression. The illness can be crippling at any age, but it wreaks an especially harrowing toll among the elderly.

Fortunately, 80 percent of those who obtain medical care for depression will see their symptoms improve, and in many cases disappear altogether. With the prevalence of depression among seniors twice as high as in the general population, it’s critical for older Americans to have access to adequate treatment.

Yet the Centers for Medicare and Medicaid Services (CMS) recently proposed a rule change that would have made it harder for seniors to get the medications they need. The sharp reversal of policy was unwise both clinically and on cost-containment grounds.

The change concerned the Medicare Part D prescription drug benefit. Thankfully, Washington lawmakers were able to halt the proposal.

But lawmakers must remain vigilant to ensure that seniors dealing with depression and other devastating illnesses continue to have access to the prescription drugs they need — as the same proposal could easily resurface in the coming months.

The proposed rule would have eroded a long-standing policy guaranteeing seniors access to medications considered vital to their health. Currently, insurers are required to cover “all or substantially all” drugs in six “protected classes” that pertain to treatments for depression, seizures, autoimmune disorders, transplant rejection, cancer, and HIV.

But, with an eye to the short-term bottom line, CMS had proposed stripping antidepressants, antipsychotics, and immunosuppressants for transplant rejection of their protected status. If adopted, insurers would no longer have had to cover the full range of therapies available. Seniors would have seen their treatment options reduced and could have even lost access to medications they’ve long taken.

The CMS even acknowledged that seniors and their doctors would have had less options in finding effective treatments. According to its own analysis, patients who currently have access to 57 mental health drugs could have seen their options dwindle to 15. Those who rely on antipsychotics, another affected class of medicines, could have seen their options slashed by 12. The agency defended reduced choice on the grounds of reducing costs.

Not surprisingly, physicians and patient advocates took a different view. They pointed to the negative impact such a change would have had on the well-being of many patients, a consideration difficult to capture solely in budget terms.

Doctors have long observed that different patients respond in different ways to the same medication, especially for complex illnesses like schizophrenia and depression. According to the largest trial of multiple medication treatment for depression, conducted by the National Institute of Mental Health, only half of the participants responded to the first treatment they received. The other half had to try up to four different treatment strategies involving multiple medication regimens before they found relief.

Not having access to a full range of medicines can have profound health consequences. Those suffering from mental illness live on average 25 years less than other Americans, due in large part to complications from treatable chronic medical conditions.