Improving America’s Mental Health Starts with Consistent Treatment Access
Even before a global pandemic exposed the challenges of social isolation and loneliness, one in five Americans were struggling with their mental health. COVID-19 only illuminated the pre-existing barriers to effective treatment and care that patients with mental health conditions face.
But even as employers have taken steps to help their workforces, your health plan could still be turning a blind eye or even making effective treatment less accessible. In fact, nothing prevents a health insurance company from abruptly changing coverage of a patient’s mental health treatments in the middle of the year.
Such unforeseen coverage changes can cause patients with mental health conditions to relapse and health care costs to rise. It’s wrong, and it’s a practice that federal and state governments should address.
Health insurers and pharmacy benefit managers (PBM) often enact sudden coverage changes by forcing otherwise stable patients to switch from their current medications to alternatives that may be older and less effective. Insurers use this strategy – often referred to as “non-medical switching” – to increase their own profits, without any consideration for a patient’s best interest or their health care provider’s recommendations.
Meet Rachel D., a patient with depression from North Carolina who experienced this practice firsthand. Earlier this year, Blue Cross and CVS Health abruptly discontinued coverage of the life-saving depression medication she had taken consistently for six years, increasing her monthly out-of-pocket cost for the medication from $15 to $300. That simple yet costly change can cause a majority of patients to walk away from the pharmacy counter emptyhanded. Consider that data tells us more than two of every three patients abandon their prescription medications when their out-of-pocket costs reach $250 or more.
In her earnest attempts to access the treatment, Rachel turned to social media for help and asked her insurance company to change their policy. “I sit here, failing on yet ANOTHER therapy, wondering how I’m going to make it through the day,” she tweeted. “Your decision has plunged me so far back into my depression that I don’t know how to get out.”
Rachel is not alone in her experience. Non-medical switches often force stable patients to ration their medication, stop taking it altogether, or replace it with a less effective drug, which can have damaging effects to a patient’s physical and mental health.
The negative impact of abrupt medication changes on treatment adherence is clear for those with a mental health condition. New data from the New England Journal of Medicine shows that discontinuation of treatment, even amongst depression patients who feel well enough to stop taking their medication, significantly increases rates of relapse. Patients with depression who lose access to effective treatment often experience serious side effects such as recurrence of depression symptoms, weight gain, and increased risk of suicide. Data from a separate study demonstrates that every switch from one depression medication to another leads to worse outcomes. For any patient who is living with a mental health condition, non-medical switching can lead to higher rates of negative life events such as hospitalizations, homelessness, and even incarceration.
Lawmakers have thankfully taken notice of the need for solutions that protect patients from non-medical switching and improve treatment access for those with a mental health condition or any other complex disease. Today, 10 states have policies that protect stable patients from midyear coverage changes that may result in sudden and unexpected non-medical treatment switches. And this August, Senators Mike Crapo (R-ID) and Ron Wyden (D-OR) of the Senate Finance Committee launched a bi-partisan effort to develop legislation aimed at eliminating obstacles to mental health treatment, calling on communities to engage in the process to help the Committee better understand how Congress can address these challenges. In November, 17 organizations signed a letter that calls on the Senate Finance Committee to address this insurance practice and protect patients from unnecessary and harmful treatment switches.
Patients deserve to know they can manage their mental health without fighting through imposing barriers that health plans put between them and their treatments. We must keep decision making power between patients and their doctors and allow patients with mental health conditions to access the medications that are most effective for their condition, without disruption.
Ashira Vantrees is a Policy Manager at the Aimed Alliance, a non-profit health policy organization that seeks to protect and enhance the rights of health care consumers and providers.
