After more than two weeks of contentious partisan debate, on July 31, the Senate completed prescription drug legislation action, without agreeing on a plan to expand the Medicare program to add coverage of prescription drugs. Over the past week, the Senate rejected four separate proposals that would have added a drug benefit to Medicare. While several of these plans were able to secure the support of a majority of senators, none were able to get the 60 votes that were required to waive budget rules (the Senate budget resolution limits available spending on Medicare prescription drug coverage, and a waiver was required for any proposal above this limit).
The Senate's failure to agree on a Medicare prescription drug benefit is a major setback for efforts to fill the largest gap in the program's benefit package - and a major concern for Medicare beneficiaries with severe mental illness (both the elderly and non-elderly people with disabilities eligible for SSDI). While there is wide bipartisan support in Congress for adding prescription drug coverage to the program, Republicans and Democrats remain far apart on key issues such as how a benefit should be delivered and whether to target coverage to only those beneficiaries with high drug costs. Democrats generally favor a benefit within the current structure of Medicare, while Republicans generally favor subsidizing private health plans that would sell coverage to beneficiaries.
NAMI will continue pressing members of Congress on the need for a prescription drug benefit under Medicare and to address the current discriminatory 50% copayment requirement for outpatient mental illness treatment services. Final Senate Legislation Contains Proposals on Reimportation and Restrictive Formularies
After the defeat of these four competing Medicare plans, the Senate did muster a majority in favor of the underlying prescription drug bill, S 812. This legislation contains three major elements that are intended to make prescription medications less expensive through access to generic substitutes and imports from Canada. The final bill also contains a proposal that would allow states to vastly expand discount programs that rely on restrictive formularies that limit access to medications that are not pre-approved lists.
One of the major pieces in the Senate-passed version of S 812 is an amendment authored by Senator Debbie Stabenow (D-MI) that would allow states to develop new programs (or significantly expand current ones) that rely on restrictive formularies that severely limit access to brand name medications. These programs, known as "supplemental rebate" programs, typically limit prescribing options to a single medication within a given therapeutic class (e.g., atypical antipsychotics or SSRIs). Many also mandate prior authorization or impose a "fail first" requirement before access is granted to an off-formulary medication. The Stabenow amendment allows states to expand these restrictions beyond their Medicaid programs and would create immunity from legal challenges against these policies brought by patient groups. NAMI opposes the Stabenow amendment as an assault on the ability of consumers and families to work with their doctor to select the most clinically appropriate and effective medication(s).
As noted above, the Senate did vote 75-24 in favor of a $9 billion package of temporary fiscal relief for the state Medicaid programs. As the fiscal pressures on states have increased in 2002 as a result of the current economic downturn, governors and state legislatures across the country have been forced make deep cuts in their Medicaid programs. In many instances these cuts have come down hardest on children and adults with severe mental illnesses. Especially vulnerable as states have moved to cut Medicaid are prescription drugs and many optional services such as intensive case management that are part of the assertive community treatment model.
The amendment passed by the Senate would provide fiscal relief to the states by increasing the federal share of the Medicaid program, known as FMAP. It would provide a temporary (18 month) increase in each state's FMAP that would a total of $6 billion. The amendment would also add an additional $3 billion to the Social Services Block Grant (SSBG) which many states use to provide community-based mental health services. NAMI supports this effort to help prevent further cuts to state Medicaid programs across the country. It is expected that the National Governors Association will make an attempt to add an FMAP increase to separate spending legislation this coming fall, given the uncertain prospects for S 812 in the House.
Support NAMI to help millions of Americans who face mental illness every day.Donate today
Inspire others with your message of hope. Show others they are not alone.Share your story
Become an advocate. Register on NAMI.org to keep up with NAMI news and events.Join NAMI Today