Category Medicare

Today the Partnership for Medicare Part D will hold a Congressional briefing to discuss the significance of Medicare’s “Six Protected Classes” policy giving seniors access to quality mental health care. While you may not be able to attend in person, it is still critical that you educate your Congressional Representative and Senators on the importance of retaining these benefits.

How Will You Protect Access to Quality Mental Health Care for Seniors?
According to the Geriatric Mental Health Foundation depression impacts more than 6 million of the 40 million Americans over 65. Health problems become more common and increasingly complex as seniors age. With the onset of more serious conditions such as heart disease, stroke, cancer, arthritis, Alzheimer’s disease, and Parkinson’s disease, individualized medicine becomes increasingly critical to helping seniors manage their mental and physical health.

This is why Congress carved out six protected classes of medications when they authorized Medicare Part D. Their intent was that seniors would have access to these medications without regulatory burdens. The preservation of the six protected classes is critical to providing treatment for serious, complex health conditions without delay or restricted access to essential treatment.

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Over the past two months, Care for Your Mind has closely followed the Centers for Medicare and Medicaid Services’ (CMS) proposed ruling around Medicare Part D’s six protected classes. Thanks in large part to the combination of the mental health community’s expert and peer perspectives as well as your insightful comments and willingness to take action to oppose this rule, CMS Administrator Marilyn Tavenner announced yesterday that the agency would not move forward to remove antidepressants and immunosuppresants from Medicare Part D’s six protected classes at this time.

Yesterday’s decis...

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Dar Walker
Executive Director of NAMI St. Louis

For nine years, Medicare beneficiaries have had access to the antidepressants and antipsychotics that work best for them. Now, a proposed change threatens to revoke that access. The resulting effect will be devastating for individuals with mental illness and their families, and costly to society at large.

It Doesn’t Add Up

Back in 2005, when the Centers for Medicare and Medicaid Services (CMS) launched the Medicare Part D prescription drug benefit, it ensured patients would have unrestricted access to life-saving medicine by granting “protected-class” status to six drug categories, including antidepressants and antipsychotics.

In granting antidepressants and antipsychotics protected-class status, CMS acknowledged that these drugs are chemically distinct and not interchangeable, and patients must have access to the full category of drugs in order to appropriately manage their Illness. In 2010, the unique nature of mental health drugs was reaffirmed when the Affordable Care Act specified that the six protected classes should remain protected.

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Dr. Scott Arbaugh
Faculty Member Washington University
Director, Geriatric Day Treatment Programs
Alton Memorial Hospital (Alton, IL), St. Joseph’s Hospital (Highland, IL) and St. Joseph’s Hospital (Breese, IL)

Speaking Up For the Silent Majority
How the proposed changes to Medicare Part D will harm middle-class seniors

As a geriatric psychiatrist in private practice, I see many middle-class patients. These are folks who have worked hard their whole lives and saved for their retirement; their homes and cars are paid for and they have a few dollars in the bank. Medicare covers the bulk of their healthcare expenses and many can afford some level of supplemental coverage.

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David Precise 
Executive Director of NAMI Louisiana

Jumping Over a Dollar to Pick Up a Nickel
How mental health policies, including the new Medicare Part D proposed rule, sacrifice patient outcomes and long-term cost control for short-term savings

There is an expression I use—jumping over a dollar to pick up a nickel—that describes ignoring one reward in pursuit of another, smaller prize. Blinded by the appeal of the shiny nickel, we ignore the dollar right beneath our feet. Too often, our nation’s mental health policies are driven by such short-sighted mentality; and too frequently, people with mental health disorders suffer as a result.

When the Centers for Medicare and Medicaid Services (CMS) recently announced a Medicare Part D proposed rule, one which would restrict beneficiaries’ access to important antidepressants and antipsychotics, I was disappointed to see yet another example of this reckless mindset. For while restricting formularies is often proposed as a way to control health care costs, we know that denying patients’ access to the full category of drugs often leads to worsening conditions and increased health costs down the road.

That’s because every human being’s brain is different and responds to treatment in different ways. If there are 20 different drugs for schizophrenia and the formulary is cut to just the four cheapest, we put individuals at great risk, and society incurs the associated health costs of untreated and uncontrolled mental illness.

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Today’s CFYM post is all about sharing your personal story. Learn how three DBSA peers traveling to Washington will share your comments from the past two weeks with Congressional Representatives. Read what affect another peer thinks the proposed CMS regulation to restrict access to quality mental health care would have had on his recovery.

For the past two weeks, CFYM has informed our readers on the misguided decision by the Centers for Medicare and Medicaid Services (CMS) to restrict access to quality mental health care. Over the past several weeks since the CMS announced a proposal to eliminate antidepressant and immunosuppressant medications from protected class status, many citizens have taken up the call to make their voices heard. As a result, last week the Senate Finance Committee sent a letter to Marilyn Tavenner, CMS Administrator asking that the regulation be rescinded. All 24 members of the Finance Committee signed the letter. Reporting on the action, BioCentury reported that the letter states “If beneficiaries do not have access to needed medications, costs will be incurred as a result of unnecessary and avoidable hospitalizations, physician visits, and other medical interventions that are otherwise preventable with proper adherence to medication,”

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Joseph R. Calabrese, M.D.
Director, Mood Disorders Program, University Hospitals Case Medical Center
Bipolar Disorder Research Chair & Professor of Psychiatry, CWRU School of Medicine
Dir., Bipolar Disorders Research Center

This week we are pleased to post the expert opinion of Joseph Calabrese, M.D. on the serious consequences of the proposed regulation to limit access to antidepressant, immunosuppressant and antipsychotic medications for recipients of Medicare Part D. Read the post and take action by participating in the conversation. This enables all of us to share these collective stories with our elected officials through e-mails, letters and in-person visits.

Why I’m Speaking Out Against the Proposed Medicare Part D Change —
And Why You Should, Too

Last month the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would initiate major changes to prescription drug plans under Medicare Part D. These changes would severely limit access to medications that are commonly used to treat serious mental illness and create serious challenges for people who have these mental health disorders.

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The Centers for Medicare and Medicaid Services (CMS) wants to significantly limit access to antidepressant and immunosupressant medication for people subscribing to Medicare Part D. Read today’s post to learn why you should be concerned, and what you can do to support the mental health community by raising our voices in Washington.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would remove antidepressants and immunosupressants from the protected class status under Medicare Part D and is considering removing antipsychotics from the same status the following year. If CMS adopts its proposal, it would reduce patient access to and the availability of mental health treatment.

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