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.
On this blog a few days ago, Andrew Sperling of the National Alliance on Mental Illness raised questions about access to mental health treatments under the Affordable Care Act (ACA); and he voiced concerns about people being able to receive the specific mental health drugs they require once the health reform law is implemented.
As Mr. Sperling pointed out, restricting access to a full class of drugs and limiting prescribers’ option to one drug per class—which health plans can opt to do under ACA—can be short-sighted from an economics standpoint and disastrous from a health perspective. Without access to clinically appropriate medication, individuals with mental illness have higher rates of emergency room visits, hospitalization and other health services.
As Chair of the New York State (NYS) Senate Committee on Mental Health and Developmental Disabilities, I understand that in order to manage the health of people living with serious mental illness, patients need guaranteed access to the full range of drugs and services that are most likely to improve their health. Even more important, I recognize that no one understands a patient’s needs better than his or her healthcare provider; and it’s presumptuous—if not irresponsible—to remove decision-making authority from that provider.
The Patient Protection and Affordable Care Act (ACA) offers new choices for quality, reliable, low cost private health insurance and opens Medicaid to more people living with mental illness.
Under the law, all health plans are required to provide certain categories of benefits and services—so-called Essential Health Benefits (EHB). One of these is prescription drugs.
A question mark as to prescription drug coverage
While plans will be required to cover a minimum number of prescription drugs used to treat mental health conditions in a therapeutic class, each plan may choose to cover different medications; and the number of covered drugs will vary by state and by plan. Most significant, the law does not require plans to cover all drugs in a particular therapeutic class. As a result, medical and behavioral health plans can avoid covering specific drugs that, in your physician’s judgment, best address your needs.
This poses serious challenges for individuals who are in need of multiple drugs per class, particularly people with serious and persistent mental illness, chronic conditions and disabilities. Antipsychotic medications, for example, are not clinically interchangeable, and providers must be able to select the most appropriate, clinically indicated medication for their patients. What’s more, physicians may need to change medications over the course of an illness as patients suffer side-effects or their illness is less responsive to a particular drug, and patients requiring multiple medications may need access to alternatives to avoid harmful interactions.
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...
Connect With Us