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National Council deplores shortsighted proposal that would deny mental health medicines, leading to increased hospitalizations and adverse events

Washington, DC (January 13, 2014) — On January 6, the Centers for Medicare and Medicaid Services (CMS) proposed to remove antidepressants and immunosuppressants from the protected class status they received under Medicare Part D in 2015, and to remove antipsychotics from that status in 2016. Despite growing public concern for the nation’s unmet mental health crisis, and a supposedly strong commitment to addressing this pressing need, the Administration stunned the mental health advocacy community by suddenly tacking in the opposite direction.

“We find it appalling and baffling that in light of the one year anniversary of the Sandy Hook Tragedy, not to mention the many official pronouncements of concern for helping persons suffering with mental illness, that the Administration would choose to go down this path,” said Linda Rosenberg, President and CEO of the National Council. “Once again, we learned that our community must always be prepared to fight to preserve our hard-won policy gains.”

In 2005, CMS directed that Part D formularies include all or substantially all drugs in six drug classes, including: antidepressant; antipsychotic; anticonvulsant; immunosuppressant (to prevent rejection of organ transplants); antiretroviral (for the treatment of infection by retroviruses, primarily human immunodeficiency virus (HIV); and antineoplastic. The Medicare Improvements for Patients and Providers Act created the six protected classes and the Affordable Care Act also defined them by name. Today, Medicare Part D plans must carry “all or substantially all” of the chemically distinct drugs in these categories on their formularies. For other categories, the plans can typically carry one brand-name drug and one generic drug.

For years, this important policy has ensured that Medicare recipients with mental illness — many of whom have severe and persistent mental illnesses — have access to the most appropriate drug without having to go through “fail-first” experiences or lengthy appeals and grievance processes to get the drug preferred by their doctor. Often, delays caused by these processes can result in suicide and other tragic outcomes.

The National Council, on behalf of its members and the entire mental health advocacy community, can only assume that the Administration’s proposal represents an effort to save money. However, it is also clear that the impact of denying patients the right treatments for their illness grossly outweighs the minimal projected financial savings to Medicare Part D. And further, the Administration has clearly failed to anticipate the undeniable increase in costs to Medicaid and Medicare Part A to be expected from the resulting spike in inpatient admissions.

The National Council strongly opposes this proposed rule and is marshaling its resources to fight it. These activities include convening and leading a broad-based coalition of stakeholders to roll back this dangerous proposal, as well as an active effort to engage in the regulatory rulemaking process. Comments are due to CMS on March 7.
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