CMS panel seeks guid­ance for Medi­care cov­er­age of de­pres­sion treat­ments

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dick­son

The Medi­care Ev­i­dence De­vel­op­ment and Cov­er­age Ad­vi­sory Com­mit­tee on Wed­nes­day will dis­cuss and vote on the def­i­ni­tion of treat­men­tre­sis­tant de­pres­sion and ad­vise the CMS on cov­er­age.

Men­tal-health trade groups and Medi­care ben­e­fi­ciary ad­vo­cates fear the CMS con­vened the panel to limit cov­er­age. None could point to any ma­jor re­lated con­cerns. The Cen­ters for Dis­ease Con­trol and Pre­ven­tion said an es­ti­mated 7 mil­lion Amer­i­can adults over the age of 65 ex­pe­ri­ence de­pres­sion, and an­tide­pres­sants ac­counted for some of the most costly drugs cov­ered by Medi­care Part D. Spend­ing on two of the most com­mon drugs to­taled $4 bil­lion last year.

Treat­ment-re­sis­tant de­pres­sion is com­monly de­fined as a ma­jor de­pres­sive dis­or­der that does not ad­e­quately re­spond to ap­pro­pri­ate cour­ses of at least two an­tide­pres­sants. Elec­tro­con­vul­sive ther­apy, which costs be­tween $300 and $800 per treat­ment, is a con­tro­ver­sial al­ter­na­tive if drugs fail. About eight ECT treat­ments are typ­i­cally needed to ob­tain re­sults.

The Na­tional Al­liance on Men­tal Ill­ness will speak at Wed­nes­day’s event to en­sure that ac­cess to ser­vices al­ready ap­proved by the CMS are not taken away or di­min­ished as a re­sult of de­ci­sions made by the panel. Sui­cide rates can be es­pe­cially high in in­di­vid­u­als with treat­ment-re­sis­tant de­pres­sion, ac­cord­ing to An­drew Sper­ling, di­rec­tor of leg­isla­tive af­fairs for NAMI, although he didn’t have spe­cific fig­ures.

“If they limit ther­apy for peo­ple with the most chal­leng­ing forms of de­pres­sion, that would be a bad thing,” Sper­ling said.

While the CMS has the fi­nal say on cov­er­age mat­ters, it of­ten fol­lows the ad­vi­sory com­mit­tee’s sug­ges­tions.

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