Providers Should Call the Shots in Mental Health Care, Not Insurers

X
Story Stream
recent articles

Since leaving the U.S. House of Representatives in 2011, I've dedicated my professional life to fighting for full implementation and enforcement of the Mental Health Parity and Addiction Equity Act of 2008  – a law I had the honor of authoring with Congressional colleagues in true bipartisan spirit. 

The law requires most insurers to cover illnesses of the brain, such as depression or addiction, no more restrictively than illnesses of the body, such as diabetes or cancer.

Among other things, MHPAEA was written to ensure equitable prescription drug coverage for mental health conditions. This is important for people like me, who rely on health insurance for treatment. Equitable drug coverage means that we are able to work with our doctors to try different prescription medications until we find what works. The process can take months, sometimes years. Striking the right balance is not always easy, but once the appropriate adjustments are made, results are often life-changing. At the end of the day, having more choices means having more opportunities to get well.  

This reality is now being threatened for millions of seniors and people with disabilities who depend on Medicare Part D plans, which are federally subsidized but sold and administered by private insurance companies. 

As an advocate for others with mental health and substance use disorders, I am extremely concerned by a new rule proposed by the Trump administration that will weaken the "six protected classes" provision in Medicare's Part D prescription drug benefit. 

This important patient protection requires Part D plans to cover "all or substantially all" anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants. These drugs treat depression, anxiety, and bipolar disorder, as well as HIV, cancer, and other chronic conditions. 

Without the provision, insurers could potentially exclude protected-class drugs from Part D plans. Dozens of antidepressants and antipsychotic drugs could be dropped from coverage, thereby restricting physicians' prescribing power and their ability to effectively treat mental health conditions.

The new rule would also enable insurers to expand the use of "step therapy," which allows them to force Medicare patients to try cheaper protected-class drugs even if they have been stable on a different drug for years. Older drugs may have to be proven ineffective, before newer treatments are made accessible. Patients may have to wait months before their insurance will cover a drug recommended by their doctor.

Such restrictions and delays involving potentially lifesaving drugs are not only reckless, they are flat-out dangerous. According to a survey from the National Council for Behavioral Health and the National Alliance on Mental Illness, half of psychiatrists who practice in community mental health centers say formulary restrictions, prior authorization, and step therapy requirements inhibit patients' access to treatment. Medicare beneficiaries may end up abandoning their prescriptions entirely, with potentially fatal results. Each year, some 125,000 Americans die from a failure to take their medicines as directed.

The Trump administration's proposed rule represents a quick-fix approach to a complex issue. Mental health care is not one-size-fits-all. What may look good on paper doesn't always translate to the human experience. It is the responsibility of lawmakers to understand situational nuances, listen to trained professionals who are on the front lines of care, and consider the true impact of short-sighted "policy solutions" on patients and their families.  

Forcing doctors to care for patients with the equivalent of one hand tied behind their back is not the answer to high drug prices and out-of-pocket expenses. 

By reducing patients' access to treatment options, the proposed rule will place a burden on the very people who need our support. Seniors and those with disabilities deserve better. We must stand up for their right to quality care. I urge my former colleagues in Congress to do everything in their power to block the rule.

Patrick J. Kennedy, former U.S. Representative (D-RI), is the founder of the DontDenyMe.org and author of the New York Times bestseller "A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction."

Comment
Show comments Hide Comments