CVS: Don’t Leave Depression Patients in the Dark During the Worst Days of the Pandemic
During the shortest days of year, the effects of depression are only heightened and intensified amid COVID-19. Recent data paints a devasting picture of depression symptoms across all age groups during the pandemic, putting many at increased risk of suicide. Amid the realities of the public health response to the coronavirus, including calls for social isolation and a resulting breakdown of traditional support systems, maintaining effective treatment is vital for patients with depression.
Despite that fact, CVS Caremark intends to eliminate coverage for certain depression medications at the beginning of the new year, which would force patients to switch their treatments and leave many patients more vulnerable than ever. At a time when depression patients have few places to turn for hope, CVS should continue to cover critical depression medications for those who rely on them in order to maintain effective management of their condition and their overall health.
Depression is a significant mental health condition that affects mood, behavior, and physical functions, including the ability to eat, sleep, and work. Left untreated, depression can affect all aspects of a person’s life and put them at increased risk of suicide. Americans have recently reported depression symptoms at a rate three times higher than before the COVID-19 pandemic, and an estimated 53 percent of college students experienced depression during the fall 2020 semester.
Selective serotonin reuptake inhibitors (SSRIs) are a common type of antidepressant medications. Today, there are seven FDA-approved SSRIs on the market, but no two SSRIs are interchangeable, meaning they will not achieve the same results for any given patient. Studies have demonstrated that depression patients who discontinue one SSRI product and start another may not tolerate or respond to the second product as well. Finding the right SSRI treatment can take time for patients with depression, but once they do, maintaining access to that treatment is critical.
This fall, CVS Caremark announced that it intends to exclude coverage of four SSRI products from its formularies beginning on January 1, maintaining coverage for just one brand-name SSRI in 2021. CVS is essentially threatening to impose non-medical switching on patients who are steadily managing their depression symptoms on their current SSRI treatments. Non-medical switching happens when an insurance company or pharmacy benefit manager (PBM), like CVS Caremark, forces patients to switch their medication purely for cost or access reasons, with no medical justification.
CVS is essentially attempting to insert itself into treatment decisions that should remain between patients and their doctors. As a result, patients with depression could lose access to their effective treatment and could experience significant adverse effects, including recurrence of depression symptoms, depression-related hospitalizations, weight gain, and increased risk of suicide. Data illustrates that every switch from one SSRI to another yields worse outcomes.
Compounding these challenges is the reality that one in five patients with depression who are forced to completely abandon one SSRI before switching to another experience the effects discontinuation syndrome, which can include nausea, irritability, anxiety, insomnia, and seizures, just to name of few. For some patients, these symptoms can last a full year.
Insurers and pharmacy benefit managers often enact non-medical switching on a whim without notice, leaving patients and their prescriber with little opportunity to effectively manage a switch in treatments in a medically appropriate way. It can also take weeks or even months for a doctor and patient to find the right dosage of a new SSRI before a patient begins to control his or her symptoms again – if the patient ever does.
While CVS and other health plans may enact non-medical switching in an effort to increase its own profits, often this method proves both dangerous for patients and does nothing to reduce consumer costs in the long run. One study demonstrated that patients with depression who were forced to switch their SSRI medication incurred higher healthcare costs in just three months following the switch compared to those who remained stable on their current medication. Another study found that patients who were forced to switch their antidepressant medication had $3,000 more in total health care expenditures than those who did not.
The darkest days of the year and the darkest days of the coronavirus pandemic have created a perfect storm for those with or at risk for depression. And while the CDC has advised those who experience depression to seek or maintain treatment, CVS is saying it wants to shut the door on many of the most effective options. Now is not the time.
CVS Caremark should allow stable patients to remain on their current SSRIs in 2021. If they don’t, it could mean darker days ahead for those who are struggling to find anywhere else to turn for help and hope beyond their medication.
Stacey Worthy is counsel to Aimed Alliance, a non-profit health policy organization that seeks to protect and enhance the rights of health care consumers and providers.