Federal Proposal to Limit Access to Psychiatric Medications Causes Concern

Jan 14, 2014

On Jan. 6, the Federal Center for Medicare and Medicaid Services proposed a rule that would limit access to certain psychiatric medications under Medicare Part D.

Currently, the Medicare Part D program protects access to medications for six classes of medications, including antidepressants and antipsychotics. A new rule proposed by the Center for Medicare and Medicaid Services (CMS), which administers this program, would eliminate this “protected” status for antidepressants immediately and would eliminate protections for antipsychotic medications in 2015.

Currently, Medicare Part D plans now must include “substantially all” medications in six protected classes on their formularies (a list of preferred medications offered by a health plan). As a result, these plans have been unable to impose prior authorization, “fail first” requirements, or other mechanisms for limiting access to psychiatric medications, practices that create barriers to accessing medications for people who live with mental illness. 

The rule proposed by CMS would lift these protections immediately for two of the protected classes, antidepressant and immunosuppressant medications, and would lift these protections for antipsychotic medications in 2015. Consequently, choices of medications would significantly narrow for individuals with depression, schizophrenia and other mental illnesses.

At a time marked by growing public recognition of America’s mental health treatment crisis, this proposed rule is both untimely and contrary to the goals of improving access and quality of care for people living with mental illness. By undoing one of Medicare’s signature protections for persons with mental illness, the rule disregards scientific understanding that psychiatric medications are not interchangeable. A medication that works for one person does not necessarily work for another person. Prescribing decisions must be individualized, based on clinical history, side effect profiles and personal preferences. Medications are a critical component of an array of services and supports vital to health and recovery for many people with mental illness.

NAMI has grave concerns about this proposed rule and is working with other advocacy groups to urge that it be reconsidered. In the coming weeks, NAMI will offer and guidance to help advocates participate in lending their voices to this important effort. Mental illness affects everyone. It’s time to stand up and demand better care, access to effective treatment, services and supports and ensure a promise of recovery.

Take action! Contact your U.S. Representative and Senators and ask them to communicate with CMS that they oppose implementation of this proposed rule.