CMS panel seeks guidance for Medicare coverage of depression treatments

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.