Monday, March 3, 2014

Medication Choice Provides Greater Hope

By Mary Giliberti, NAMI Executive Director

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.

6 comments:

Janine Curtin RN said...

Thank you, Mary for addressing this issue. I am a nurse who has worked in mental health and seen the effects of this firsthand. Changing a medication that has helped someone achieve recovery because their insurance no longer covers it can have catastrophic consequences. Please continue to educate and advocate for the priority to be that a person's medications be covered based on treatment effectiveness - and not cost effectiveness.

Unknown said...

This is outrageous what CMS is proposing. In a time of Parity in mental health they will be taking measures to dismantle peoples treatment!
Why is it that other insurance must meet the Parity standard but Medicare doesn't?
This doesn't make sense.

Moss said...

I have yet to meet a doctor who sees medication as "one path to an outcome". They all have seen it as "you have to do this, and keep doing it the rest of your life". And the facts say that long-term medication outcomes are almost universally bad.

I was on "medication" from the time I was 12 until I took myself off all meds just prior to my 51st birthday. I felt drugged, held down, underwater, however you want to say it. I have now been "medication"-free since November 2003 and feel great.

What is worse, doctors tend to find an easy diagnosis, and one which their guides call for "medication" early and often -- if one doesn't work, try two or three. I was diagnosed bipolar, and it took a courageous doctor just this past year to honestly evaluate my situation and determine that I was autistic (which does not have drug "therapies"). So for 49 of my 61 years, I was given the wrong diagnosis and the wrong treatment, and have fun finding a doctor willing to listen to you. Their entire system calls for hearing "key words" and making the diagnosis on that.

And NAMI stigmatized me as badly as anyone -- as soon as I started looking for alternatives to my "treatment", they started calling me "radical" and found ways to undermine my recovery.

So go ahead and live in your private garden. I will enjoy my life outside of a psychiatrist's "care" and seek the help I need.

By the way, I am now employed (something I couldn't handle on drugs) helping developmentally- and intellectually-disabled individuals in a home setting.

courtney g said...

I really enjoyed and had the pleasure of reading this article. As a 25 year old African American its pleasing to hear about our history. I was unaware of the mental disorders that we developed but, also wasn't surprised. I can only imagine waking up to fear every day of my life, how cruel. I also always wondered why February was the chosen mother for our history month but after reading the history of the important dates I totally understand. My mother always pushed/encouraged the education of our history on me and my other sibling because she always said they will never teach you these things in school. Yes she was right the things that Ive learned as an adult is mind boggling. Now that Im a mother I choose to do the same thing. Thank you name for such a great article and flashback of our history. this month I decided to refresh my history and each week at least one time post and article on facebook to share with my followers. I even posted my experience of the racial taboo video and encourage all my friends regardless of their race to check the video out

Anonymous said...

Nice post

Lauren Smith said...

If you want to live a healthy and safer life, you will have to rely on a doctor for curing the common infections and illness. What if the doctor becomes a cause of a great suffering because of his reckless attitude? Well, I would simply suggest you to move ahead for filing the medical negligence claim against the irresponsible medical practitioners and doctors to get compensated for the losses suitably.