Coverage tagged posts

How Can We Achieve Mental Health Parity If There Are Not Enough Practicing Psychiatrists?

A provider’s perspective on the limited access to mental health care

Dr. Philip R. Muskin
Professor of Psychiatry
Columbia University Medical Center

As a practicing psychiatrist and patient advocate, I strongly believe that equal treatment and quality care should apply to someone who has a chronic mental health illness, like schizophrenia or major depressive disorder, requiring ongoing therapeutic and complex medical management, just as would apply to a patient in need of cardiovascular treatment or other chronic medical issue.

I’m troubled and frustrated by the rash of recent studies finding that patients across the United States are unable to obtain a timely appointment with a local mental health provider, notably a psychiatrist, who accepts their insurance coverage. This growing problem, old news to those of us practicing in the field, is multi-faceted and a fix will require a significant commitment to change on the part of many involved in the delivery and financing of health care. Unfortunately, it’s not clear such a commitment yet exists.

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If Access is Lacking, Do We Have Mental Health Parity?

Carolyn Beauchamp
President and CEO, Mental Health Association in New Jersey
Mental Health Association of NJ Finds Access to Providers Lacking 

Rhonda’s story 
Rhonda, a young woman living with both bipolar disorder and an eating disorder for most of her life, was frustrated. She’d been trying for weeks to find a new psychiatrist, after being released from an inpatient clinic, where she was treated for a severe bipolar episode. On a list of 15 providers, several were simply unreachable, either wrong numbers or no answer. When she got through to the others, they were either not accepting her insurance or had a 4-6 week wait for an appointment. She felt distraught and hopeless. She didn’t know how she would cope.

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Medicare Part D Users are Feeling the Squeeze

If concerns about being able to retain access to the correct medications to treat their mood disorders was not enough, individuals utilizing Medicare Part D must also be concerned about whether or not they can even afford to take their prescribed medications.

When Medicare Part D took effect in 2006, it arrived with mixed reviews. Today, according to a survey conducted by Medicare Today, 86% of seniors say they are satisfied with their prescription drug plan. One reason they site for the satisfaction is that the costs are reasonable. Given the way things are trending however, the Center for Medicaid and Medicare Services (CMS) may see satisfaction dip.

Cost related non-adherence to medication protocols is growing. The inability to pay for costly medicines causes patients to stretch out their prescriptions by skipping or taking smaller doses than prescribed. In in a recent Health Affairs study, (Medication Affordability Gains Following Medicare Part D Are Eroding Among Elderly with Multiple Chronic Conditions) seniors experiencing four or more chronic conditions reported a cost-related non-adherence rise from a low of 14.4% in 2009 to 17% in 2011.

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Speak Out About Potential Reductions to Medicare Part D Benefits

Last Tuesday, September 30, DBSA participant Trudy Lapin shared her story during two Congressional briefings sponsored by the Partnership for Part D Access. Trudy used her time to explain to Congressional staff from both the House and the Senate why a proposed regulation by CMS to restrict access to medication that aids in the treatment of mood disorders is misguided. You can read Trudy’s statement below, and learn how you can share your story with your own elected officials.

Treatment is not one size fits all
Although I was first diagnosed officially with major depression in 1993, signs of that particular mood disorder appeared in childhood. While attending college, an over achieving pattern went into high gear. I elected a double major in French and English literature with a minor in secondary education. I graduated with highest honors; accepted a full fellowship to Yale Graduate School to pursue my doctorate in Romance Languages and Literatures; taught French language, literature, and film at Yale College and at the University of Chicago; and was awarded a National Endowment for the Humanities grant, where I enjoyed the privilege of working with humanities scholars at Princeton University.

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How Will You Protect Access to Quality Mental Health Care for Seniors?

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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It Doesn’t Add Up

Walker_St LouisNamiDar 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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Speaking Up For the Silent Majority

Scott-ArbaughDr. 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)

Today’s CFYM post, illustrates the struggles seniors are having obtaining appropriate medication. Click here to provide a comment to CMS and ask them to rescind their proposed regulation restricting access to antidepressant and antipsychotic medications. The deadline for entering comments is this Friday, March 7, 2014 so please act today and make your voice heard!

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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CMS, Rescind Your Policy to Restrict Access to Mental Health Care: Our Voices are Being Heard

LarryDrainToday’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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