One of Medicare’s key patient protections – the six protected classes – is under threat by a new proposal from the Trump Administration. Feedback from the public will be critical in deciding whether or not they move forward — that’s why it’s essential that you let your voice be heard.
The Trump Administration has proposed a new rule that would change Medicare Part D, removing the requirement that Part D prescription plans cover “all or substantially all” medications in six “protected” classes: anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. Why does this matter to us?
Medicare beneficiaries received some good news during the recent federal budget negotiations. Due to the fact that there is no Cost of Living Adjustment (COLA) for 2016, coupled with an increase in Medicare Part B premiums, 2016 monthly Social Security payments would have been smaller in 2016. But a last minute budget deal prevented that calamity. The budget that passed and was signed by President Obama did not include any Social Security (COLA) increases, but it did remove or delay the Medicare Part B premium increases for the majority of seniors. The net result: most seniors will not see a decrease in their monthly payments.
Additionally, Americans receiving Social Security Disability payments were spared a potential 20 percent decrease for 2016 due to a long-standing deficit in the fund. That’s because, of the 12.4 percent combined employee and employer contribution to the Social Security trust funds only 1.8 percent is allocated to the disability fund. Congress alleviated some of the burden by increasing this contribution to 2.37 percent over the next three years, giving Congress time to come up with a long-term solution.
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.
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.
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.
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...
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.
You Care, Help Share During Mental Health Awareness Month Families for Depression Awareness
For Mental Health Awareness Month, Families for Depression Awareness has launched #YouCareHelpShare, a campaign to provide education and encouragement to family caregivers. Through the distribution of caregiver education materials and a social media awareness campaign, we aim to help caregivers all across the U.S. get the support, information, and resources they need to be effective partners in care.
The importance of caregivers
Caregivers of people with depression or bipolar disorder play a crucial role in their loved ones’ lives. Parents, spouses, siblings, and other close connections are pivotal in recognizing a problem, accessing care, and lending sup...
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