Tragic California Case Exposes Failings in Our Mental Health Care System
CareforYouMind Feb 10,'15
In April 2012, Fred Paroutaud, a California man with no history of mental illness, experienced a psychotic episode. Mr. Paroutaud was hospitalized and diagnosed with bipolar disorder. Just 72 hours after he was admitted, and despite the fact that he was still experiencing hallucinations, he was discharged and referred to outpatient group therapy. Because his condition remained unstable he requested alternate therapy and one-on-one sessions with a psychiatrist. He was denied both by his health plan and his condition deteriorated.
Concerned by his worsening depression, his wife appealed to the health plan again and again. She pleaded that her husband required more supervised and personalized treatment. While waiting for an appointment with his psychiatrist, and just two months after his first psychosis, he died by suicide.
Mr. Paroutaud’s widow is convinced that if more intensive and timely care had been available, her husband would still be alive. In October 2013, she and two other plaintiffs filed a class-action lawsuit against the health plan claiming they were harmed by its systemic denial of timely access to mental health services.
Why this story sounds familiar
Those two narrow levels of care are appropriate for many people, but not all, and certainly not for all stages of mental illness. The absence of those critical, in-between levels of care is one of the ways that our mental health system falls short and where it fails people like Fred Paroutaud and his family.
When someone is in the midst of a manic episode or considering suicide, hospitalization can provide the opportunity to stabilize the condition. Upon discharge, many patients require medically monitored care in a residential facility or highly personalized care in a medically-monitored outpatient setting. Unfortunately, that level and type of care is almost impossible to find in commercial health plans.
There is another way
This structure, with six levels of care, is the backbone of the mental health system under California’s Medicaid system, and it provides a complete, stepped approach to rehabilitation.
This type of care should not be exclusive to the Medicaid population. One of the 10 essential health benefits under the Affordable Care Act is rehabilitation; another is mental health care. This means that rehabilitation for mental health care isan essential benefit, and all Americans in commercial health plans are entitled to more rehabilitation-focused mental health services.
What you can do now
With increased national attention on access to mental health care, now is the time to tell us about the problems you are having in accessing the care you need. We want to know what services you were denied and the barriers you faced, such as unaffordable out-of-pocket costs, transportation issues, or lack of trained providers in your plan’s network, etc. We also need to know what you did or didn’t do in response and how this impacted your or your family member’s recovery. As advocates and advocacy organizations, we are positioned and prepared to knock on the door of government regulators and health plans and point out the disparity in care and demand access to appropriate rehabilitative services.
Many commercial insurers don’t cover rehabilitation services because they don’t believe they have to. And if no one demands otherwise, they are unlikely to ever change. Share your story. Don’t take ‘no’ as the only answer. Let’s realize the parity we deserve.
Rusty has been Executive Director and Legislative Advocate for CCCMHA since 1987. He is co-author of California’s Mental Health Services Act, a tax on personal incomes over $1 million to expand community mental health care. At CCMHA, he has been instrumental in moving forward a variety of critical mental health-related initiatives, including ensuring the implementation of the federal Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program to serve children with severe emotional disturbances. He also serves as Executive Director of the Mental Health Association in California.
about Bipolar Disorder
What are some symptoms of BP? See what bipolar disorder can be like. Pass this along to someone in need. Dark Glasses & Kaleidoscopes - YouTube http://bit.ly/1ExeuNA
Allen Doederlein reflects on 2014
Allen Reflects on Thriving in 2014
As DBSA’s 2014: The Year of Thriving comes to a close, it seems appropriate to reflect on what we’ve accomplished this past year, and to think about what’s yet to come.
At the beginning of 2014, we outlined our vision of a future where every adult and child living with a mood disorder has the opportunity not just to survive, but to thrive. To some, this was a message of hope; to others, it seemed a goal almost impossible to imagine. I completely understand how some of my peers might find total wellness to be an unattainable goal. Indeed, I too have experienced times in my life when the only reality I could imagine was the intense pain of depression. In fact, I experienced times this very year when thriving seemed so very far away for me personally. But amidst messages about the danger and drain of people with mental health conditions, and my own concurrent thoughts of self-loathing and self-stigma, to know that there was a community that would hope for the return of my best self was a blessing. To hold hope when we cannot carry it ourselves: this has always seemed, to me, the fundamental purpose of peer support. DBSA was founded on a model of peer support, and DBSA will always be about creating opportunities for peer support, and through peer support—the thousands of people meeting in communities across the country—we are creating a world in which all of us may be reminded of our potential, our strength, and our best selves.
For me to return to a place of thriving took a lot of time and work and collaboration. It also took some luck. For I have been very lucky: to have found clinicians that do not put limitations on what my life can be; to have the support of loved ones and colleagues who remind me of who I am, not what condition I live with; to have insurance that gives me access to quality health care that covers both my physical and mental health; and to find inspiration in my work and the amazing people I have the privilege of working with, and for, in my role at DBSA.
Such good fortune—in clinical collaboration, in supportive community, in access to resources, in meaningful work—are what I, and the DBSA Board and staff, want for everyone, not just the very lucky.
So in 2014, we asked our peers, families, clinicians, researchers, politicians, and the public to expect more. We asked our community to promote and seek full wellness—because better is not well, and everyone deserves the opportunity to thrive.
I am proud of the work DBSA accomplished in 2014, and I encourage you to review our 2014: Year of Thriving programs. I believe that we did open minds—and even a few doors—to the possibility of thriving. A few highlights include:
But so much more must be done. So we ask,
“What needs to happen for us to have wellness change from being a possibility for some to a probability for most?”
It will require:
We made some significant strides this past year, but we do not fool ourselves by believing that these first steps have produced monumental change. That will take persistence. That will take courage. That will take time. That will take hope. That will take ALL of us.
It is through thousands, indeed millions, of inspired, imperfect actions that we will slowly transform these small steps into big changes and create a future where wellness is no longer a possibility for only some lucky few, but a probability for all.
Thank you for joining us on this journey,
Mental Illness Awareness
The death of the Murphy Bill: On being the national spokesman
The Murphy Bill as we know is dead. The Republican leadership in the House announced a change in strategy. They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.
It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so. It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.
Part of the problem was Murphy himself. He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform. He wasnt. Being a psychologist certainly didnt qualify for the role. Neither did being a member of the House of Representatives. It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered. In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.
He didnt understand that leadership was built or that it was a two way street. He alienated people who had lived mental health reform their entire adult lives. He thought it was about them joining him and never seemed to know it was the other way around. And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.
He was naive. The only people who believe federal laws change everything are federal lawmakers and most of them know better. To say that his law was going to prevent the next shooting was simply ego. He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.
Mental health reform is an ongoing effort by many, many people with different values and priorities. Sometimes it is its own worst enemy. People who cant stand each other have a hard time standing together for anything. Murphy I hope has to some degree taught people they can find unity despite their differences. And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.
He may indeed try again. He probably will. Dr. Torrey most surely will. He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.
Thanks for the support
by Larry Drain, hopeworkscommunity
The following organizations have offered support of "Dear Governor Haslam". They have put links to this site or printed the letters on their websites. I really appreciate it. I invite you or your organization to do the same.
Tennessee Health Care Campaign.
Tennessee Citizen Action.
Tennessee Disability Coalition.
Tennessee Chapter Depression and Bipolar Support Alliance.
WRITE GOVERNOR HASLAM TODAY
hopeworkscommunity | June 1, 2014
More on our speaker series
We recently announced the beginning of our speaker series in Blount County sponsored by Maryville Nami. Our first speaker on March 20 will be Sita Diehl National Director of State Advocacy for Nami national. I am very excited today to announce our second speaker today. On April 24 Doug Varney Commissioner for Dept of Mental Health and Substance Abuse will be coming to speak in Maryville. Tentatively his topic will be the scourge of drug abuse, particularly prescription drugs and meth, their relationship to mental health issues and efforts by the state to address these issues. It should be a great and informative evening. Please do all you can to spread the word about both of these presentations.
A New Speaker Series
Mental health issues topic of presentations
By Linda Braden Albert | [email protected] | Posted 14 hours ago
A series of presentations on mental health issues will begin Thursday at the Blount County Public Library. The first presentation is by Sita Diehl, past executive director of the National Alliance on Mental Illness (NAMI) Tennessee and currently national director of state advocacy for NAMI National.
Larry Drain, recently named president of NAMI Maryville, said, “When they asked me to take the job, I really wanted to figure out a way not only to help NAMI but to help the community. Every day, nowadays, when you read the paper or watch TV or whatever, in one way or another, mental health issues are there. There’s a lot of bad information, misinformation, so the idea I had was that if we could bring a series of people to Maryville to talk about mental health issues, that would be a real, real positive thing for this community.”
Diehl’s current position entails her traveling from state to state, organizing efforts to make outcomes for mental health possible in each state, Drain said. “I’ve known her for years, and she was the very first person I asked. Her topic will be about finding support, whether you’re a family member, whether you’re somebody with a mental illness. She will talk a lot about NAMI, some about the mental health system in Tennessee. There will be a question and answer period after she gets through talking. Anybody who comes will be enriched by her.”
On April 24, Doug Varney, commissioner of mental health and substance abuse services for the state of Tennessee, will speak on mental health and drug addiction. Drain said, “I think he will talk some about prescription drugs and meth, what the state is trying to do to deal with some of these things. Especially in Blount County, it is such a live issue. ... He knows the topic inside out.”
Additional speakers in upcoming months include Ben Harrington, executive director, East Tennessee Mental Health Association; Scott Ridgeway, director, Tennessee Suicide Prevention Network; Allen Doderlain, national president, Depression and Bipolar Support Alliance; Pam Binkley, recovery coordinator, Optum Health, who will talk about emotional first aid; Lisa Ragan, director, Office of Consumer Affairs, Tennessee Department of Mental Health, who will speak on peer support, recovery, etc.; and Elizabeth Power, a nationally known expert on post-traumatic stress disorder. Mental health professionals from Blount Memorial Hospital have also been invited to speak.
Drain said, “I think this will be a quality addition to the Maryville community and I hope lots of folks will come. ... For a lot of folks here, the whole area of mental health, mental health treatment, the resources involved and things like that are so confusing. My hope is that all these speakers can shed some light, bring some facts and really help people in the Blount County area.”
Larry Drain, hopeworkscommunity
Alternative to Meds Center
By: Ericka G.
The script for my success journey had already played out in the optimistic stage of my mind prior to this life-changing breakthrough. Before this perceived notion of accomplishing the most profound discovery, there lied a mental environment of opposing views. The pivotal dynamic contrast that lied dormant was the hopelessness marked by my former psychiatrist’s repetitive voice relaying that psychotic medication intake would be for a lifetime. But something deep within surpassed this voice and rang out louder representing hopefulness with the confidence to know that holistic alternatives existed with healthier ways to manage my symptoms. Therefore, I launched a mission in search for this non-conventional approach through a few browse searches on Google and suddenly a vision was birthed to one day attend the “Alternative to Meds Center”. As anticipation rose to meet the eager embrace of new found hope, the circling theme that dominated my thoughts involved the declaration of healing that stood me right in the face the night before my arrival. This arrival of recovery victory existed prior to packing my bags and stepping on the soil of Sedona, Arizona to embark upon this outstanding program here at ATMC. With the proper mindset and motivated perception, the stabilizing tone was set for past frustration to become whole manifestation.
Though healing had already taken place, I forged a goal to become totally medication free to avoid the pulsating cardiac distress fueled by the side effects of Geodon. In addition, I didn’t want to play a prolonged game of Russia Roulette by taking a risk on a harmful medication that could cause future health issues. Stable and highly productive the last 8 years, through the collective effort of remaining true to my faith in God as I properly managed my symptoms, I gained the blessing of being hospital-free during this duration. This all-inclusive, holistic approach in addressing every angle of total well-being produced excitement coupled with enlightenment and elevation. With a willing and open receptiveness, I became a thriving “sponge” with the drive to advance my knowledge of the program’s teachings, tools, and training. From the moment I started the program, the enlightening mode of taking advantage of every nugget of information to better equip myself for mental health and physical wellness became the focal point of my positive interaction. Every aspect of the program especially the counseling has propelled me to new levels of understanding the greater need for self-care through diligence and improvement all in making me a more polished individual. The beneficial knowledge I received concerning the importance of supplementation to the health-conscious meals to the intensive detoxification process worked hand and hand to cohesively promote total restoration, mental clarity, and longevity. With these practices, the collaborative effort of the staff’s supportive attitude and expert awareness of the best solutions to all of my needs made this an exceptional experience. My gratitude continues to deepen, most importantly, to Mr. Lyle Murphy for making his vision a staple reality that would be successfully influential in making a difference for so many of us.
Medicare Rule Changes May Restrict Drug Choices for Seniors
The CMS decisions about which drugs to protect were supposed to be based on whether the drugs were needed to prevent increased doctor visits, hospitalizations, persistent disability, incapacitation or death that would otherwise occur within seven days if the drugs were not given. The choices about which drugs to remove from protection fail that test because, with acute mental illness, seven days without medication could easily lead to hospitalization, incapacitation or death. The same constraint exists for some 500,000 transplant patients. Seven days without the right medication could result in transplant rejection.
The quote above is from the article linked. My jaw dropped when I read it. CMS is proposing to drop certain drug classes from the status of protected medication. The idea is to save money. The article says it may save around 10% I believe.
My jaw dropped when I read the criteria. It basically says that if doing without a drug for 7 days wont kill you, incapacitate, or put you in the hospital you really didnt need it to the point where your access to the medication is guaranteed to begin with.
WHAT ABOUT THE EIGHTH DAY??
Is it just me or does this not sound simply stupid, simply arbitrary and simply mean? How in the world do you decide as a matter of cost containment that if someone doesnt die fast enough that dont really need a medication? Who should have that kind of power?? Should anyone??
I read all the stuff about percents...percents of cost...percents of savings. There is another "p" word-- PEOPLE. Somehow it seems like it got lost.
Larry Drain at HOPEWORKSCOMMUNITY
Reminder: ACA Enrollment
ACA Enrollment Ending Soon -
Hi folks, we just want to remind everyone that the enrollment period for Patient Protection and Affordable Care Act is drawing to a close for this season. The last day to enroll will be March 31st. To be covered by April 1st, the last day to enroll is even earlier - March 15. Enrollment will start up again November 15th and go through January 15th.
Below are links to Tennessee events and resources you might contact for enrollment assistance. Please forward this email to anyone and everyone you know who needs assistance or needs to hurry up and get covered already!
If you've already enrolled we'd love to hear from you. Click here to share your story and tell us about your enrollment experience.
Thanks everyone and best of health to you from all of us at THCC
By: Tennessee Health Care Campaign
Treatment resistant depression
Beyond Antidepressants: Taking Stock of New Treatments
By RICK NAUERT PHD Senior News Editor
As science advances, new insights into the physiological causes of depressionare leading to treatments beyond common antidepressants.
A new evidence-based report authored by Murali Rao, M.D., and Julie M. Alderson, D.O., reviews a bevy of emergent treatments including newmedications, electrical and magnetic stimulation of the brain, and long-termcognitive behavioral therapy for stress management.
The study is published in the journal Current Psychiatry.
For more than 50 years, most research has been based on the theory that depression results from a deficiency of chemical messengers, called neurotransmitters, that carry signals between brain cells.
Commonly used antidepressants are designed to either increase the release or block the degradation of three neurotransmitters – dopamine, norepinephrine, and serotonin.
But drugs that target neurotransmitters, such as Prozac, Zoloft, and Paxil, succeed in inducing the remission of depression in fewer than half of patients.
This has prompted researchers “to look beyond neurotransmitters for an understanding of depressive disorders,” Rao and Alderson write.
New theories of depression are focusing on differences in neuron density in various regions of the brain; on the effect of stress on the birth and death of brain cells; on the alteration of feedback pathways in the brain and on the role of inflammation evoked by the stress response.
“Chronic stress is believed to be the leading cause of depression,” the authors write.
Long-term stress harms cells in the brain and body. Stressful experiences are believed to be closely associated with the development of psychological alterations and, thus, neuropsychiatric disorders.
In conditions of chronic stress exposure, nerve cells in the hippocampus begin to atrophy. (The hippocampus is a part of the brain involved with emotions, learning, and memory formation.)
The new depression theories “should not be viewed as separate entities because they are highly interconnected,” researchers write.
“Integrating them provides for a more expansive understanding of the pathophysiology of depression and biomarkers that are involved.”
Such biomarkers are molecules in the body that can be indicators of depression. The authors identify more than a dozen potential biomarkers depression, including monoamine regulators; proinflammatory cytokines and other inflammatory mediators; mediators of glutaminergic activity and GABAergic activity; and regulators of neurogenesis.
A bevy of new depression treatments are currently offered or on the horizon include corticotropin-releasing hormone antagonists; dexamethasone; partial adrenalectomy; long-term cognitive behavioral therapy; ketamine and other NMDA antagonists. Other treatments include benzodiazepines; anesthetics; deep brain stimulation; transcranial magnetic stimulation; exogenous brain-derived neurotrophic factor; selective serotonin reuptake inhibitors; tricyclic antidepressants; atypical antidepressants; reduction in inflammation; and anti-inflammatory drugs.
As it can often take several months to recover from depression, Rao and Alderson believe current depression treatment programs that average six weeks “are not long enough for adequate recovery.”
Source: Newswise – Loyola University Health System
A very personal plea for medicaid expansion: a letter to the governor
Dear Governor Haslam:
But my decision to write this letter is about much more than the peer support centers. In your state of the state message you talked a couple of times about the importance of government giving good customer service. You seemed to put a lot of stock in that idea. It was not the first time I have heard you speak about it. The decision to fund peer centers was a great example of good customer service.
My hope is that you will consider my request in the light of that concept. I am in a desperate situation and without your help I dont know where to turn.
I want to ask you to reconsider your stance on medicaid expansion. I know you are in a tough spot. Anything that makes the Tea Party mad faces great obstacles in Tennessee and few things make them angrier than health care reform. Perhaps what I am asking you is impossible for you to politically do. Several people have told me it is.
As I said my situation is desparate. Let me take a minute to describe it.
I have been “free” of health care insurance for many years. It is a freedom I would gladly lose. I have been told that I need surgery. The surgery is a minor one that thousands of people undergo every year. No insurance means no surgery. The doctor tells me the lack of surgery though may not be a minor thing though, that in fact if my condition should become an emergency my life may be in danger. I pray every day not to die a preventable death. Many people have far more dangerous situations than me and face far more immediate risk. Being poor should never, at least not in Tennessee be the cause of anyone’s death. And without action on your part it will be though.
My desperation though is not based purely on issues of my health. It goes far deeper than that.
My wife is disabled and has been on TennCare for a while. She is a TennCare miracle. Without it she would have died long ago. Even with all her progress without it she would no live a month. In order to save her insurance and in a very real sense her life after 32 years of marriage we have had to separate. I dont know, without TennCare expansion we can ever live together again.
The situation is very complex, but let me share it with you as briefly as I can. My wife receives SSI for disabilities. Recently I took retirement from Social Security. It was the worst decision I have ever made.
We found out that in Social Security’s eyes, even though our combined checks left us below poverty, we made far too much money. Linda lost over $700 and her check was reduced to $20 a month. I told Social Security that I would have to get a job in order for us to survive. We figured without her check we had about $40 to live on for the month of January and we just cant live like that. Who could??
Social Security told us that since her TennCare was disability based and not income based (like it would be if TennCare was expanded) that if I made over $85 a month her TennCare would be lost.
I love my wife and wont let her die. The day after Christmas we separated. The hope is that with a separate address she can regain her SSI check. My hope is to move as close to her as possible. Right now I do not see how we can ever live together again.
You do not make the rules for Social Security and none of that is your fault. The law is what it is and despite its cruelty and hurtfulness we have no choice but to do our best to live with it. A law that supports the break up of thousands of marriages seems so evil, but I dont right now see how I can affect it.
I am asking for your help though. Maybe I dont have the right but I have no where else to turn. I know you deeply love and care for your wife. What would you say to me if our situations were reversed??
Please act. Whatever the resolution please act. My wife will keep her TennCare. I will never do anything to put that in jeopardy. Without your help though my marriage will not survive and for Linda and I that is a death of a different sort.
JOIN US IN THE FIGHT
Join Us in the Fight to Save Access to Mental Health Treatment: Act Now by Telling Congress You Care!
Posted on January 28, 2014
The Centers for Medicare and Medicaid Services (CMS) wants to significantly limit access to antidepressant and immunosupressant medication for people subscribing to Medicare Part D. Read today’s post to learn why you should be concerned, and what you can do to support the mental health community by raising our voices in Washington.
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule that would remove antidepressants and immunosupressants from the protected class status under Medicare Part D and is considering removing antipsychotics from the same status the following year. If CMS adopts its proposal, it would reduce patient access to and the availability of mental health treatment.
Since it went into effect in 2006, Medicare Part D’s protected class structure ensures patients with mental health conditions have access to all or substantially all of the most appropriate medications, protecting them from “fail-first”1 experiences or other appeals processes. In many cases, delays caused by these processes can result in inadequate treatment and potentially tragic outcomes.
We need to ensure that all mental health patients have access to all the medications that they need. It is clear that CMS’ rule will signal a step in the wrong direction and the consequences will be detrimental. According to the World Health Organization, depression is currently the leading cause of disability worldwide. By 2030, it will be the leading global burden of disease.2 In the United States alone, the total direct and indirect cost associated with depression exceeds $83 billion annually.3
Ultimately if CMS’ rule is approved, there will be severe human, economic and societal consequences for not only mental health patients, but for all Americans. We must take action now.
Here’s How You Can Take Action Today
Now, more than ever, the mental health community of patients, families, friends and others need to join together to tell CMS and the Administration how big of a mistake implementing this rule will be for all Americans. Below you’ll find several ways in which you can make your voice heard during CMS’ open comment period, ending March 7,to protect antidepressants, immunosupressants and antipsychotics within Medicare Part D. The clock is ticking!
At Care For Your Mind, we understand that your personal experience and ideas can help build a mental health care system that works.
1 Fail first refers to the practice of forcing doctors to prescribe the least costly drug in any class to patients first, even if the physician wants to begin treatment with a different medication.
2 World Health Organization. http://www.who.int/mediacentre/factsheets/fs369/en/
3 Greenberg, et al.(2003).The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64, pp. 1465-1475
DBSA Opposes CMS Proposal to Eliminate Access to Mental Health Treatments as Part of the "Six Protected Classes"In a misguided effort to save money, CMS proposal would deny vital treatments for people with mental health conditions who are covered under Medicare Part DChicago, IL (January 17, 2014)
On January 6, the Centers for Medicare and Medicaid Services (CMS) circulated a proposed rule that would remove antidepressants and immunosupressants from the protected class status they received under Medicare Part D in 2015, and to remove antipsychotics from that status in 2016. Despite a growing public recognition of America’s mental health treatment crisis, the Administration inexplicably proposed undoing one of Medicare’s signature protections for people with mental health conditions by suggesting that when it comes to drug treatment one size fits all.
“DBSA advocates for the right of people with mental health conditions like depression or bipolar disorder to choose their own paths to mental, emotional, and physical wellness,” stated Allen Doederlein, President of DBSA. “Implementation of this proposed ruling has the potential not only to undermine hard-won treatment advances a person with a mental health condition may have made, but also to undermine a person’s ability to choose the right treatment that a clinician identifies as the best fit for a serious, life-threatening condition.”
For nearly a decade, the “six protected class” policy has ensured that Medicare patients with mental health conditions, many of whom have severe, treatment-resistant symptoms, have access to the most appropriate drug without having to go through “fail-first” experiences or lengthy appeals and grievance processes. Often, delays caused by these processes can result in suicide and other tragic outcomes, and inadequate treatment leaves people open to relapse, co-occurring conditions which greatly shorten lifespans, and increased suicide risk.
Commenting on the proposed ruling, Joseph R. Calabrese, MD, Director, Mood Disorders Program, Bipolar Dis. Research Chair & Professor of Psychiatry and Dir. Bipolar Disorders Research Center at Case Western Reserve University, stated “the effectiveness and tolerability of antidepressants can vary greatly among people who choose this treatment option. Our extensive clinical experience demonstrates that the best therapy for one person may be ineffective or poorly tolerated in another individual. Moreover, successful treatment frequently involves trial of several different medications in a quest to find the best treatment in terms of efficacy and tolerability. As a result, it is important that people with mental health conditions have access to a wide variety of treatments and that clear information about these options is available both to clinicians and the individuals they serve and treat.”
We understand that the Administration's proposal represents an effort to save money. However, CMS has clearly failed to anticipate the predictable increase in costs to both Medicaid and Medicare Part A from the resulting spike in inpatient admissions. The Depression and Bipolar Support Alliance strongly opposes this proposed rule and is joining other stakeholders in the fight against it. These activities include submitting comments to the regulatory rulemaking process which are due on March 7.
Background: In 2005, CMS directed that Part D formularies include all or substantially all drugs in six drug classes, including: antidepressant; antipsychotic; anticonvulsant; immunosuppressant (to prevent rejection of organ transplants); antiretroviral (for the treatment of infection by retroviruses, primarily human immunodeficiency virus (HIV); and antineoplastic. The Medicare Improvements for Patients and Providers Act created the six protected classes, and the Affordable Care Act also defined them by name. Today, Medicare Part D plans must carry "all or substantially all" of the chemically distinct drugs in these categories on their formularies. For other categories, the plans can typically carry one brand-name drug and one generic drug.
S.L. Brannon D.Div..