Medicare Prepares Reversal on Covering All Antidepressants and Antipsychotics

The Medicare program appears to have reversed itself and now is seriously considering removing anti-depressants and antipsychotics from its “protected” status on Part D drug plan formularies. Six drug categories—immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineo-plastics—are protected. This means that Part D plans must offer “all or substantially all” of the chemically distinct products in those categories. Elsewhere on the formulary, the plan needs to offer only 2 product selections in each category, often a brand name and a generic substitute.

“I am not naive; they are reserving the right at a future date to whack out antidepressants and antipsychotics,” acknowledged Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness (NAMI).

The announcement by the Centers for Medicare and Medicaid Services (CMS) that it would consider elimination of some or all of the 6 protected categories came in the form of a proposed rule issued on October 22. That proposed rule revised 2 key definitions the CMS had adopted in an interim final rule it published on January 16, 2009. The definitions implement new requirements for Part D drug coverage established by a 2008 congressional law. The comments that came in over the next few months on those interim definitions essentially convinced the CMS that the definitions the agency proposed in January—which would determine the future of the protected categories—were too broad and needed to be narrowed. The Obama CMS essentially reversed Bush administration decisions and sided with the Part D drug plans and their pharmacy benefit managers and against drug manufacturers and patient advocacy groups, such as the American Psychiatric Association (APA) and NAMI.

Full Story Medicare Prepares Reversal on Covering All Antidepressants and Antipsychotics – Psychiatric Times.