Medicare plan will hurt those with severe mental illnesses

Over the last several years, the FDA has approved a number of medications to treat severe mental illness that have the advantage of lasting for weeks or months at a time. These drugs have proven successful in treating conditions such as schizophrenia, bipolar disorder, and opioid addiction and offer options and hope to individuals and families living with these illnesses. Unfortunately, a new proposal by the Centers for Medicare and Medicaid Services (CMS) could undermine access to these life-changing therapies.

Schizophrenia is a complicated and often hard to treat illness that strikes young people on the brink of adulthood. Schizophrenia can shatter the plans young adults have for themselves and the dreams of their families. But, with the right treatments, we can keep a young patient in school or in a job and avert lifelong disability.

There is much we do not know about schizophrenia, but we do know that medications, specifically long-acting injectable antipsychotics, can be critical to treatment and recovery. One-third of all prescriptions for oral medications go unfilled and more than half are taken incorrectly. When medications aren’t taken as prescribed, conditions can worsen, resulting in ER visits and hospitalizations.

Long-acting injectable medications offer an alternative delivery mechanism that frees people from prescription regimens calling for them to take multiple pills every day. A monthly appointment to receive medication can make for a much better outcome and can save money. A sharp decrease in schizophrenia-related hospital admissions has been demonstrated with the use of injectable, when compared to oral, medications. We should be striving to increase the availability of these life-changing medications. Unfortunately, the opposite is happening.

Currently, injectable medications are underutilized due to prescribing barriers. Despite federal parity laws, doctors face requirements to first try and fail with an oral drug and insistence on prior authorization. Ultimately, these requirements force patients to endure unnecessary hardship and wait times to receive the care they need. Additionally, clinics that administer these medications are struggling to cover costs.

On top of these existing burdens, a new proposal by CMS would cut reimbursements for these drugs and further limit access to them. At a time when mental illnesses and addictions are getting unprecedented policy attention it is ironic that we are proposing to limit available treatments. That's a step in the wrong direction.

CMS knows these medicines are important. The Center for Medicare and Medicaid Innovation, recently funded a project called Care Transitions Network for People with Serious Mental Illness in New York which explicitly seeks to increase the use of injectable medications for persons with serious mental illness as a strategy to reduce readmissions. If all goes as planned, the Care Transitions Network expects to avoid 1,150 hospitalizations and $12.6 million in costs in the first year. Over the four-year life of the project, 16,000 hospitalizations – and $186 million in spending – may be avoided. 

The CMS proposal could hurt this project as well as patients across the country that would benefit from injectable medications. Fortunately, there is a glimmer of hope. Dozens of patient and physicians groups have expressed serious concerns, and House and Senate lawmakers on both sides of the aisle have called on CMS to withdraw its proposed rule. We join these congressional leaders, advocates and practitioners in urging CMS to reconsider. Medications that help the people who most need our support should be accessible to all. The cost of this proposed rule is unacceptably high.

Rosenberg is the President and CEO of National Council for Behavioral Health.