Commentary: Changes to Medicare Part D could limit treatment

By Lauren Simonds

When it comes to mental illness and access to care, Washington ranks in the bottom half of the states.

Unfortunately, if Congress gets in the way, Washingtonians’ access to care could become even worse.

In a misguided attempt to cut costs, Congress is currently pushing changes to Medicare Part D, the program’s prescription drug benefit. Altering Part D could restrict access to care for serious mental illnesses, as well as for other devastating chronic conditions.

Currently, Washingtonians have access to a variety of plans. Almost a half-million people in the state are enrolled in one of Part D’s 21 health plans. Some plans feature premiums as low as $14.60.

Seniors can thank the private sector’s involvement in Part D for these affordable plans. Private insurers drive a hard bargain and negotiate substantial discounts on drug prices. These discounts cut 35 percent off drugs’ list prices, on average. Insurers then use these savings to create low-cost, high-quality plans for seniors.

Part D’s cost effectiveness has exceeded government expectations. The average monthly premium is about half of the originally forecasted $60. The cost to taxpayers has also been way below government estimates. Total costs for Part D are $349 billion less than initial projections. The program has widespread approval; 9 out of 10 seniors claim they’re satisfied with their coverage.

So if Medicare is saving patients and taxpayers money, what’s the problem?

Some federal lawmakers think that Medicare isn’t saving enough money. So they’ve proposed two different “solutions” to increase savings.

One is to let the government negotiate drug discounts directly with pharmaceutical companies. Part D’s federal “non-interference” provision currently bans the government from doing so.

The only problem: government interference wouldn’t save any money. The Congressional Budget Office has repeatedly concluded that lifting Medicare Part D’s non-interference provision would have a “negligible effect on federal spending.”

It would, however, disrupt the quality of care Part D provides patients. The CBO concluded that the only way the government could lower drug prices would be to restrict access to medicine. Certain treatments for depression, schizophrenia, bipolar disorder and other mental illnesses could be dropped from coverage. Or patients could be forced to try an older treatment before their insurance plan pays for a newer medicine.

Mental illnesses are complex — a drug that works great for one patient might not work at all for another. Forcing patients to switch to a different treatment based on a government formulary could cause them to relapse into mental illness. For instance, patients who switched from the brand to the generic version of the antidepressant Fluoxetine experienced more anxiety, a relapse or worsening of depression, and a relapse of obsessive-compulsive disorder.

The Veterans Affairs system is a good example of what happens when government interferes with drug price negotiations. The VA simply refuses to cover medicines it deems too pricey. As a result, there are far fewer drugs available to veterans than there are to Part D beneficiaries. One study found that the VA covers 16 percent fewer top prescription drugs than Part D plans.

To compensate for this skimpy coverage, 54 percent of veterans buy separate drug plans. More than a fifth of these veterans are enrolled in Part D.

The other “solution” is to activate the Independent Payment Advisory Board, or IPAB. This unelected board would have the power to unilaterally reduce Medicare reimbursements for certain medicines. Such cost-cutting could lead to rationing of care.

Lets make sure patient outcomes stay at the center of the conversation around federal programs. The government does not need to get involved in drug price negotiations, nor should it. Medicare Part D works perfectly well without federal interference.

Lauren Simonds is the executive director and CEO of the National Alliance on Mental Illness of Washington.