NYS Council Adamantly Opposed to Draconian Changes
to Proposed Part D Formulary Changes
On January 6, the Centers for Medicare and Medicaid Services (CMS) proposed to remove
antidepressants and immune-suppressants from the protected class status they received under
Medicare Part D in 2015, and to remove antipsychotics from that status in 2016. Despite growing
public concern for the nation’s unmet mental health crisis, and a supposedly strong commitment
to addressing this pressing need, the Administration stunned the mental health advocacy
community by suddenly tacking in the opposite direction.
In 2005, CMS directed that Part D formularies include all or substantially all drugs in six drug
classes, including: antidepressant; antipsychotic; anticonvulsant; immunosuppressant (to
prevent rejection of organ transplants); antiretroviral (for the treatment of infection by
retroviruses, primarily human immunodeficiency virus (HIV); and antineoplastic. The Medicare
Improvements for Patients and Providers Act created the six protected classes and the
Affordable Care Act also defined them by name. Today, Medicare Part D plans must carry "all or
substantially all" of the chemically distinct drugs in these categories on their formularies. For
other categories, the plans can typically carry one brand-name drug and one generic drug.
For years, this important policy has ensured that Medicare recipients with mental illness —
many of whom have severe and persistent mental illnesses — have access to the most
appropriate drug without having to go through “fail-first” experiences or lengthy appeals and
grievance processes to get the drug preferred by their doctor. Often, delays caused by these
processes can result in suicide and other tragic outcomes.
The NYS Council can only assume that the Administration's proposal represents an effort to save
money. However, it is also clear that the impact of denying patients the right treatments for their
illness grossly outweighs the minimal projected financial savings to Medicare Part D. And
further, the Administration has clearly failed to anticipate the undeniable increase in costs to
Medicaid and Medicare Part A to be expected from the resulting spike in inpatient admissions.
The NYS Council strongly opposes this proposed rule and is marshaling its resources to fight it.
We will be working with our advocacy partners to roll back this dangerous proposal, and we will
engage in the regulatory rule-making process. Comments are due to CMS on March 7.
The NYS Council for Community Behavioral Healthcare is a statewide membership association representing
NY's community mental health and addictions treatment organizations. Together with our 100 member
organizations, we serve our state's most vulnerable citizens including adults and children living with mental
illnesses and addiction disorders. We are committed to ensuring all New Yorkers have access to
comprehensive, high-quality care that affords every opportunity for recovery and full participation in
community life. For more information, visit our online home at: www.nyscouncil.org or call Lauri Cole,
Executive Director, at (518) 461-8200.