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Shelley Starkey

Congressional Briefings Discuss Threats to Mental Health Medication Access

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A recently proposed rule from the Centers for Medicare and Medicaid Services (CMS), if enacted, would threaten Medicare Part D participants’ access to critical prescription drugs including those often needed by individuals living with mental illness. The Partnership for Part D Access, of which the National Council for Mental Wellbeing is a founding member, hosted two briefings Wednesday on Capitol Hill to educate Congress on the negative impacts of this proposed rule and to ask them to urge CMS to reconsider its proposal.


Under current law, Medicare Part D plans are required to provide access to all or substantially all medications within the “six protected classes,” including critical prescription drugs that support patients with mental health conditions, epilepsy, Parkinson’s disease, lupus, HIV/AIDS, cancer, and organ transplants. The proposed rule would allow Part D insurers to require patients who have been stabilized on a medication regimen for years to try different, cheaper medications or receive prior authorization when they enroll in or switch between Part D plans, resulting in potentially catastrophic consequences.


Laura Kay Roth, a docent at the Smithsonian and a woman living with bipolar disorder, diabetes, and hypertension shared during the briefing that she has been stable for nine years on a complex drug regimen that is carefully designed to balance her co-occurring health challenges, and that she has been able to afford it thanks to medication access via Medicare Part D. “Mental health care has helped me turn my life around and thrive,” said Roth. “I cannot begin to think what would happen if I lost my medications for my bipolar disorder. Those medications are as important if not more important to me than my insulin for diabetes or my medication for hypertension.”

Although the Trump Administration insists that the proposal will lower costs in the Part D program, the briefings’ panelists agreed that the move is short-sighted, and while it may save a few dollars on prescription drugs, the costs of potential hospitalizations and further treatment that these changes may necessitate in stable patients could far outweigh any benefit.

Panelists emphasized the weight of such consequences and the counter-productive nature of the proposal which seeks to give insurers more flexibility within the six protected classes. Kelly Brantley discussed a recent study from Avalere Health, where she is the Managing Director, which demonstrates that Medicare Part D plans are already utilizing tools available to them to help manage the cost of medications across the protected classes.

“These proposed rules only attempt to manage costs in a silo,” said Chad Worz, Executive Director and CEO of the American Society of Consultant Pharmacists. “They don’t look at the downstream effects.” Philip Gattone, President and CEO of the Epilepsy Foundation who also has an adult son living with epilepsy, agreed saying, “Access to these medications needs to be protected because it really is a matter of life and death.”

The National Council strongly opposes any changes that would introduce barriers to treatment for individuals living with behavioral health conditions.