Providers should make the call in mental health care, not insurers
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.
MHPAEA was written to ensure equitable prescription drug coverage for mental health conditions. 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. 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.
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 conditions.
Without the provision, insurers could exclude protected-class drugs from Part D plans.
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.
Such restrictions are flat-out dangerous. Medicare beneficiaries may abandon their prescriptions entirely, with potentially fatal results. Each year, some 125,000 Americans die from a failure to take their medicines as directed.
Mental health care is not one-size-fits-all. It is the responsibility of lawmakers to listen to trained professionals who are on the front lines of care, and consider the true impact of short-sighted “policy solutions” on patients.
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 bestseller “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”