February 24, 2024


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Insurance roadblocks hamper access to vital mental health care

3 min read

COVID-19 is wreaking havoc on Americans’ mental health.

One in three Americans now suffers from severe anxiety, and one in four battles depression, according to recent Census Bureau data. Texts to federal emergency mental health lines are up 1,000% for the year. And a May survey from the University of Chicago found that four out of 10 respondents felt a sense of hopelessness at least once a day.

Sadly, insurance companies are exacerbating the mental health impact of the pandemic by making it needlessly difficult for patients to access antidepressants, antipsychotics and other desperately needed medications. Their actions don’t just jeopardize Americans’ health. They also inflate health care spending in the long run.

I’ve long advocated for equal access to treatment for those with mental health and substance use disorders. And I’ve personally struggled with my own challenges. So, I know the importance of prescription drug regimens firsthand.

Depression, schizophrenia, bipolar disorder and other mental health conditions are often caused by chemical imbalances in the brain. Medication is a key tool — alongside behavioral therapy — in treating these conditions and enabling long-term recovery.

For example, selective reuptake serotonin inhibitors, a common form of antidepressant, can reduce symptoms of depression by up to 60% and lead to complete remission in many patients.

But the health insurance industry regularly impedes patients’ access to such life-changing medications.

Consider the practice of “step therapy,” which forces patients to try lower-priced, older generic drugs before they are permitted to use newer, more effective ones. Patients and their doctors must prove the cheaper options don’t work before they can “step” up to the more advanced medicine.

In practice, that means patients’ symptoms must get worse before insurers will cover prescriptions for more effective drugs.

Similarly, “prior authorization” practices require doctors to call an insurance company and obtain approval before prescribing certain drugs. This process is notoriously — and deliberately — bureaucratic and time-consuming. The hope is that doctors will just go ahead and prescribe the older, cheaper medicines.

Both of these practices harm patients’ health. Over 90% of physicians say prior authorization negatively impacts clinical outcomes, according to a survey from the American Medical Association. And over half of all psychiatrists working in community mental health centers cited prior authorization, step therapy and other formulary restrictions as the No. 1 barrier to prescribing an ideal drug regimen, according to a survey from the National Council for Behavioral Health and the National Alliance on Mental Illness.

Roughly two-thirds of practitioners from that same survey said restrictive medication policies lead to increased hospitalization rates, emergency room visits and soaring healthcare costs.

Decisions about medications should remain between patients and their doctors. Insurance roadblocks are not just intrusive, they are outright counterproductive.

That’s because it’s generally far cheaper to manage someone’s mental illness with medication than let it spiral out of control, which often leads to lengthy, even more expensive hospitalizations. For example, according to research from the Congressional Budget Office, boosting the number of prescriptions filled by Medicare beneficiaries by just 1% saves the program 0.2% on other medical services.

We recently celebrated the 30th anniversary of the Americans with Disabilities Act, a landmark piece of legislation — championed by my late father, Sen. Ted Kennedy — that established powerful protections for Americans struggling with mental illness. While we have made great strides over the past three decades, there’s still much work to be done.

Our Congressional leaders cannot ignore the role that insurer practices such as step therapy and prior authorization play in continued discrimination against those with mental health and substance use disorders. Patients and their families deserve better.

Patrick J. Kennedy, a former U.S. representative (D-R.I.), is the founder of DontDenyMe.org and author of the New York Times bestseller “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”

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