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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Rep. Murphy Calls CMS to Task for Proposal Limiting Mental Health Drug Access

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Congressman Tim Murphy (R-PA) has written to the Centers for Medicare and Medicaid Services (CMS) asking the agency to justify its decision to strip key mental health drugs of their protected status in Medicare. Stating that “the CMS proposal appears not to be grounded in a concern over  beneficiary health,” Murphy asked the agency to account for the rationale behind its controversial proposal issued earlier this month.

On January 6, CMS issued a Notice of Proposed Rulemaking establishing new criteria for which classes of drugs would receive protected status in Medicare. CMS argued that antidepressants and immunosuppressants fail to meet these criteria and would be removed from protected status beginning in 2015. Although the agency also determined antipsychotic drugs do not meet the criteria, it proposed temporarily allowing them to remain protected while it explores the possibility of establishing a transitional policy.

In his letter, Murphy said he was “dismayed to learn that CMS is proposing to remove depression drugs from the protected classes, and is considering the same change for antipsychotic medications… The proposed rule fails to address [CMS’] past acknowledgement that Medicare beneficiaries require access to medications in therapeutic classes where different drugs are not interchangeable.”

Murphy called CMS to task for issuing a rule that appears to place “rebate-negotiating leverage” over beneficiary health, referring to the lengthy section of the rule in which CMS discusses how the proposed change could help Part D drug plans negotiate lower prices with manufacturers. He asked the agency to explain in detail how beneficiary health was taken into consideration during the development of the proposed rule. He also asked for a detailed justification based in medical literature of how the agency determined that failure to receive clinically distinct antidepressant and/or antipsychotic medications within seven days (the standard set forth in the criteria) would not result in substantial harm to patients. Finally, his letter challenged CMS to provide evidence explaining how limits on legitimate, on-label prescribing of mental health medications will help reduce the off-label use of these drugs to treat dementia – another key argument put forth in the proposed rule.

Congressman Murphy is the author of the Helping Families in Mental Health Crisis Act (H.R. 3717), which includes a provision permanently codifying the six protected drug classes in federal law. This legislation, which has 26 cosponsors, would ensure that Medicare patients continue to have access to all or substantially all antidepressant and antipsychotic medications.

The proposed rule has been widely criticized by mental health consumers, providers, and other stakeholders for limiting access to lifesaving drugs in Medicare and shifting costs onto other healthcare programs such as Medicaid. The public comment period is open through March 7th; stay tuned to Capitol Connector and the National Council’s Action Alerts to read our comments and learn about opportunities to take action.