Medication Choice Provides Greater Hope

Mar. 03, 2014

There is no one path to recovery.

One size does not fit all.

These sometimes are hard facts to accept, because they mean there are no simple answers; however, they are still a source of hope for people living with mental illness.

More choices mean more hope. When there are several options to choose from, a person has a better chance of getting it right in finding an effective course of treatment. The key is working with a doctor and making decisions based on a person’s specific circumstances and life goals. Getting it right also means avoiding unnecessary side effects or risks. It means getting the right help in time.

NAMI needs your help now to send a message to the federal government’s Center for Medicare & Medicaid Services (CMS), which has proposed limiting access to certain psychiatric medications under the Medicare Part D program for seniors and people with disabilities. We are preparing to file a formal “comment” this week along with thousands of signatures on a petition in opposition to the proposal. We hope to have at least 10,000 signatures. Please help by signing here and sharing it with family, friends and others. We also urge you to send comments to CMS with your stories and those of people you know and love.

It doesn’t matter whether choice involves medication, therapy, a support group, help from a peer, or an exercise routine. The principle is the same. Access is critical and barriers should be minimized. Choice is important and so is timing. As one woman who communicated with me explained, it can take time to find the right treatment. “What I learned is that different people respond to different medications differently. It is not a one size fits all. It took 10 years for me to find the right balance of medication and I had a very skilled doctor that cared and a lot of medications to choose from until we got it right. Taking away (these) choices limits a person’s ability to find the right combination.”

Currently under Medicare Part D, health care plans must include “all or substantially all” medications in six protected classes of medications in their “formularies,” i.e., the list of medications the plans cover. This requirement has prevented insurers from imposing prior authorization, “fail first” requirements or other restrictive mechanisms that limit access to other options.

CMS’s new rule proposal would eliminate protections for antidepressant medications in 2015 and antipsychotic medications in 2016. Overall, choices of medications would be greatly narrowed for individuals with depression, schizophrenia and other mental illnesses. For too many people, steps would be taken backward, rather than toward recovery—and stepping back means pain and risk of increased hospitalization, criminal justice involvement and despair.

Early effective treatment often hinges on making a smart choice at the outset rather than depending on a cheap cookie-cutter option. In addition, people with disabilities, including mental illnesses, have to wait two years to get onto Medicare, and by then many of these individuals have experience and know which medications work and can be tolerated well. We shouldn’t make them jump through a number of hoops the get the right help. We know from experience that imposing complex processes interferes with good treatment.

In response to one of my previous blogs, I received a comment from a mom whose son’s medication dosage was arbitrarily reduced by a private insurer after many years of stability and over the objections of his doctor. She asked for help and did not know where to turn. Placing the burden on doctors, individuals and families to overcome barriers to treatment makes no sense. The CMS proposal flies in the face of scientific knowledge and the personal experiences of many people living with mental illness. Prescribing decisions must be individualized, based on clinical history, side effect profiles and personal preferences.

Medication is usually just one part of the foundation needed to support a person’s recovery from mental illness. Weaken any one part of the foundation and years of progress, are put at risk. Make sure that CMS knows the impact of this rule on real people and real lives. Join the NAMI movement and take action today – sign a petition, submit a comment, and tell CMS why Medicare Part D must continue to support recovery.

Read more about the proposed rule and review the comments to our previous NAMI Facebook post on this issue.

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