Stakeholder Voices

Dr. Viviek Murthy

Surgeon General Nominee

If there are rules that limited access to medications that are helpful to people with mental health disorders, then I would certainly seek to bring my clinical experience, prevention experience, and mental health experience to bear in discussions [with CMS] about that. I think people having access to adequate treatment is very important.

Dr. Viviek Murthy
Rep. Tim Murphy

Rep. Tim Murphy

House Energy and Commerce Oversight Subcommittee Chairman

I was dismayed to learn that CMS is proposing to remove depression drugs from the protected classes, and is considering the same change for antipsychotic medications in 2015. The seriousness of your proposal, and the unexplained change in the Agency’s thinking, is of grave concern to me and millions of senior citizens relying on access to these medications. [...] The Proposed Rule fails to address the Agency’s past acknowledgement that Medicare beneficiaries require access to medications in therapeutic classes where different drugs are not interchangeable. The CMS proposal appears not to be grounded in a concern over beneficiary health. Instead, the proposal seeks to increase profits through increased rebate-negotiating leverage for private Prescription Drug Plans Sponsors or insurers.

Howard Dean

Former Governor of Vermont, DNC Chairman

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.”

Howard Dean
Linda Rosenberg

Linda Rosenberg

President and CEO of the National Council

We find it appalling and baffling that in light of the one year anniversary of the Sandy Hook Tragedy, not to mention the many official pronouncements of concern for helping persons suffering with mental illness, that the Administration would choose to go down this path. Once again, we learned that our community must always be prepared fight to preserve our hard-won policy gains.

Epilepsy Foundation

The Epilepsy Foundation strongly opposes the Centers for Medicare and Medicaid Services (CMS) proposal to eliminate three of the six protected classes in Medicare Part D and calls on CMS to provide meaningful access to physician directed care for all Medicare beneficiaries, especially the most vulnerable patients that the six protected classes was designed to protect. Restricting vulnerable patients’ access to necessary and appropriate medications is penny wise and pound foolish, and will lead to higher costs for the Medicare program.

Epilepsy Foundation
National Kidney Foundation

National Kidney Foundation

Without the current protections, Part D plans, not doctors, will decide which immunosuppressive drugs patients can access. This proposal reflects a misunderstanding by CMS that immunosuppression to avoid organ rejection is a one-size fits all therapy. Patients and transplant physicians know that there is no one drug combination that works for every patient. Some patients may experience harmful side-effects with a particular drug combination that might work wonderfully for someone else. It takes a delicate balance to properly suppress the immune system in order to preserve the organ, while minimizing side-effects for each patient.

Carl Schmid

Deputy Executive Director of The AIDS Institute

Medicare Part D, including the 6 protected classes, is working. Beneficiaries, including those with HIV, are able to access the medications that their doctors prescribe. We don’t understand why the Obama Administration would propose to diminish that access.

Carl Schmid
Kenneth Thorpe

David L. Shern, Ph. D

President an CEO of Mental Health America

For many mental health consumers, access to the full range of the most effective medications is a crucial component of successful treatment and recovery. Such medically necessary psychotropic medications, and their combination with other services and supports, are often essential to permit people with mental health and substance use conditions to recover and to lead healthy and productive lives in their communities.

Ron Honberg

Director of Policy and Legal Affairs at NAMI

At a time marked by growing public recognition of America’s mental health treatment crisis, this proposed rule is both untimely and contrary to the goals of improving access and quality of care for people living with mental illness. By undoing one of Medicare’s signature protections for persons with mental illness, the rule disregards scientific understanding that psychiatric medications are not interchangeable. A medication that works for one person does not necessarily work for another person. Prescribing decisions must be individualized, based on clinical history, side effect profiles and personal preferences. Medications are a critical component of an array of services and supports vital to health and recovery for many people with mental illness.

Ron Honberg
Allen Doederlein

Allen Doederlein

President of the Depression and Bipolar Support Alliance

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. “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.

Kenneth Thorpe

Chairman of the Partnership to Fight Chronic Disease

The logic in maintaining these protected classes is inarguable. Medicare beneficiaries coping with serious, chronic illnesses should have access to the medications that they and their physicians have deemed the most effective treatment for their conditions. Medications are not interchangeable. One drug can have vastly different effects, and side effects, on different patients. Thus, Medicare Part D is structured to ensure that patients who require antidepressants, antipsychotics and immunosuppressants (critical drugs for patients who have undergone organ transplants) have access to the unique medicines they need to protect their lives and health.

Kenneth Thorpe
Dr. Joseph R. Calabrese

Dr. Joseph R. Calabrese

Case Western Reserve University

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.

Paul Howard and Yevgeniy Feyman

The Manhattan Institute

One reason Part D beneficiaries have such strong access to necessary drugs is because Medicare requires coverage of “all or substantially all” drugs in six “protected” drug classes. CMS’ new regulations essentially cut this down to three drug classes. [...] If there are inappropriate prescribing trends, CMS can address those concerns through targeted communications with patients and prescribers, fines or sanctions against providers, and working with professional associations to ensure physicians are using the latest evidence-based guidelines.

Paul Howard and Yevgeniy Feyman

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