It takes someone with a seriously high IQ to totally figure out Medicare. I mean, an Ivy League education failed to prepare me for the Part As, Part Bs, Secondaries, Supplementals, and–oddly missing a Part C, as far as I can tell–the Part Ds. If you have yet to encounter this system, my strong recommendation is that you start preparing yourself–now.
To simplify enormously–and allow myself to cut to the chase–let’s just posit that Medicare Part D covers your meds. True, every other insurance plan you’ve ever had covered your treatment and medication in one kit and caboodle–but this is your government, they’re here to help you.
So Part D is indeed a U.S. federal government program which subsidizes the costs of prescription drugs for those on Medicare.
So far so good, right?
And, no surprise, the federal government is way over budget this year (as opposed to any other year, I suppose). Medicare actually accounts for a whopping 16% of the federal budget, a percentage only expected to increase as baby boomers age into the program.
In fact, when they finally re-opened the government on the 17th of October last year, after days of dilly-dallying about, President Obama specifically named Medicare as a program that had to be looked at if it was going to be around long-term.
And the President walked the walk in his fiscal 2014 budget, in which he proposed $5.6 billion in Medicare payment cuts for that year alone.
And now we all know one way Medicare proposes to make those cuts:
The Federal Center for Medicare and Medicaid Services (CMS) has put forth a proposal to restrict the availability of antidepressant (in 2015) and antipsychotic (in 2016) medications as part of their Part D program.
Part D plans can do this in a variety of ways [and may I recommend here that, if you haven’t spent the amount of time arguing about medication approval that I have, and the word ‘formulary’ isn’t part of your everyday vocabulary, you might want to just skip to the part where I don’t explain the problem with cutting these meds (I’m trusting you, here, readers, with some basic insight; don’t let me down)]:
- excluding specific drugs from formularies;
- requiring prior authorization from formularies;
- requiring fail first requirements (I shine here; I’ve tried so many meds that when the insurance companies start with a ‘fail first’ approach I couldn’t be happier); or by
- imposing high deductibles.
Look–I could start here by beginning to explain why this is a poor idea, why the 1 in 17 people in the US who suffer from serious mental illness shouldn’t have their access to medications that might be life-altering restricted. But I think it’s insulting–I have no doubt that you can figure out why having a chronic schizophrenic jump through hoop after hoop in order to be able to receive treatment from an antipsychotic is, to put it mildly, a poor idea.
So, what to do.
Well, as always, thank goodness for NAMI, the National Alliance for the Mentally Ill. For while I get riled up and start wondering who in the world thinks cutting access to medication for people with psychosis is a good idea, NAMI gets practical, and I ask that you follow their path.
CMS actually opened themselves up for comments on this proposal–all due by March 7, 2014. But in the meantime, NAMI has provided both access to the emails of your Representative and Senator, and, just in case you couldn’t think of anything to say on this topic (I had no such problem; feel free to write if you’re looking for more verbiage and NAMI’s fails to impress you), a basic text for you to utilize in your protest about these upcoming changes.
Scroll down to the about the bottom third of NAMI’s “Act Now to Prevent Restrictions on Psychiatric Medications in Medicare!” page and you’ll see the form letters, one to your Rep and one to your Senator.
Feel free to just send the form letter. Or add some details from the experience of a friend whose life was changed by Lexapro, or whose bipolar was finally managed by Zyprexa. Or tell your own story.
But don’t let the government restrict access to antidepressants and antipsychotics without putting in your two cents. It may seem esoteric now, but one day it might make all the difference in the world to you or someone you love.
