Government Aims at Mentally-Disabled Elderly to Reduce Medicare Drug Costs
NEW YORK (MainStreet) The Centers for Medicare & Medicaid Services (CMS) is searching for more ways to tighten its belt. Its newest cutting proposal may be shortsighted for the large numbers of elderly patients. Among other things, CMS is proposing the elimination of antidepressants and immunosuppressants next year for Medicare beneficiaries who have private Medicare Advantage and Part D prescription drug plans. The federal government expects to save $1.3 billion between 2015 and 2019, if the proposed rule passes.
"The proposed polices to the Medicare Advantage and Prescription Drug programs will ensure that Medicare beneficiaries have access to affordable health and prescription drug plans while making certain that plans provide value to Medicare and taxpayers," a CMS spokesperson said. "It would improve health care quality, reduce costs for Medicare beneficiaries enrolled in Medicare Advantage and prescription drug plans and give us new tools to combat fraud, waste and abuse.".
In what amounts to the power of a line item veto, the gift of excision came courtesy of the Affordable Care Act (ACA). Originally, CMS required all Part D plans to cover "all or substantially all" drugs within six classes: antineoplastics, anticonvulsants, antidepressants, antiretrovirals, antipsychotics and immunosuppressants. Under the new proposal, CMS will keep drugs classified as antineoplastics, anticonvulsants, antiretrovirals, although there are even proposed exceptions to that. However, CMS will no longer require Part D formularies to include drugs from the antidepressant and immunosuppressive classes. Antipsychotic drugs will remain on Part D formularies, at least through 2015.
Diseases that affect the elderly -- cardiovascular disease, for example -- can have along with them, depression. Drugs for other diseases often seen in the elderly, such as Parkinson's Disease, can cause hallucinations, which sometimes need to be treated.
Further, there are many people in the elderly population who suffer from brain disorders, such as depression, anxiety, bipolar disorder and others.
The CMS proposal includes criteria for identifying drug classes for which only the inclusion of all drugs within it are clinically necessary for treatment. CMS states that among other things, "appeals protections can ensure clinically appropriate access for the overwhelming majority of drug categories and classes, including drug categories and classes of mental health drugs."
The National Council for Behavioral Health, an umbrella organization for community mental health and substance use treatment organizations, calls it a "dangerous" proposal. It wants patients to continue to 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." The National Council points out that delays in appropriate treatment can result in tragedy.
CMS will be accepting comments on the proposed rule until March 7, 2014.
--Written by S.Z. Berg for MainStreet