Containing Health Costs Is Good But Not at the Expense of the Mentally Ill

For years, the consensus among politicians from both sides of the aisle has been that our health care system is flawed, broken, and in need of reform. Through passage and implementation of the Affordable Care Act (ACA), we have already seen some commonsense reforms made that most policy makers believe are well overdue, such as expanding those covered by health insurance by allowing young adults to remain on their parents' health insurance plans for longer and preventing discrimination against individuals with pre-existing conditions.

Most policy makers also agree that the most important decision makers when it comes to health care are patients and providers. However, proposed regulatory changes to Medicare Part D challenge this principle, and it is critical for our elected officials to get involved to ensure these changes are not implemented as proposed.

Recently, the Centers for Medicare & Medicaid Services (CMS) put forth a proposed rule that would make unprecedented changes to the six classes of medication that are specifically protected under Part D. Historically, these protected classes have existed to ensure patients have access to critical prescription drugs. These proposed changes endanger that safeguard.

Patients suffering from mental illness are likely to suffer the consequences of this rule more than any other populations. The proposed rule would make significant changes to the availability of antidepressants and antipsychotics. Implementing these changes will bring additional risk to an already vulnerable population.

Mental health is an increasingly significant issue in the United States and resources, both private and public, should be targeted at fostering understanding, improving the lives of patients, and reducing the toll mental illness takes on our society. By limiting the number of drugs available to this population, regulators will create another barrier to treatment for patients suffering from mental illness.

By proposing this rule, regulators are signaling to patients, providers, and the American people, that the government can make unilateral decisions that limit treatment options for those who gain health insurance coverage through a government program. This is a dangerous precedent, not only for the elderly and uniquely vulnerable populations the rule will impact immediately, but also for the millions who will soon rely on government-guided plans under the ACA.

This proposed rule is unnecessary. Medicare Part D is one of the most cost-effective health programs that have been implemented to date. Since its inception, the program has ensured that elderly and at-risk individuals have affordable access to life-saving medication and has done so while staying under budget and below predicted costs. There will be little additional cost savings from this rule, since mental illness is likely to become more difficult to manage with more and longer periods of disability for the patients.

While containing costs is critical to the longevity of Medicare, cost cutting that impairs patient care leads to disintegration of quality in our health care system. We need improvements and big ideas, but creating artificial barriers that distance patients and providers from controlling decisions about their care is not the answer. Instead, efforts to decrease Medicare costs and reform the current system must focus on increasing efficiency, promoting overall health, and moving to a payment system that does not reward illness, but instead creates incentives for keeping patients well.