After a year of upheaval and devastation brought on by COVID-19, many Americans crave nothing more than a return to normalcy.
But normalcy in any form will elude us until we address a growing American crisis: access to mental health care. Why, then, are some healthcare companies erecting barriers?
If we have any hope of recovering from the pandemic — both physically and mentally — these companies and the policymakers who regulate them must make mental health services and medications easier — not harder — to get.
The other pandemic: mental health burdens
COVID-19 hasn't just caused widespread respiratory illness, it's also spawned a mental health crisis. A Centers for Disease Control and Prevention (CDC) survey showed that 42% of Americans experienced symptoms of anxiety or depression in December 2020, up from 36% in April. According to one analysis, rates of depression are double pre-pandemic levels.
The grief and trauma — both individual and collective — from more than 400,000 COVID-19 deaths amplify and, for some people, create mental health burdens. Early evidence suggests the COVID-19 virus itself may cause depression or other mental health symptoms. In fact, some experts speculate that as many as 30% to 50% of people who get sick with COVID-19 could develop mental health issues.Financial hardships born of economic disruption and widespread unemployment exacerbate these burdens. A recent study showed that people with lower incomes and less savings had greater risk of depression symptoms. People with fewer financial resources struggle to absorb routine costs such as copays and to afford medications if insurance won't cover the drugs they need.
Blocking access to mental health treatments
Effective January 1, 2021, CVS-Caremark removed 57 drugs from its formulary (or list of approved medications) in the name of "helping clients save money while ensuring members have access to clinically appropriate medications."
In reality, these changes create administrative burdens for healthcare providers and patients alike and make it harder for patients to get treatment for conditions like depression.
Among the drugs removed were several brand-name antidepressant and antipsychotic medications, including six selective serotonin reuptake inhibitors (SSRIs). In place of these brand-name drugs, patients must get the generic equivalent.
Formulary changes are not only administrative hassles; they can worsen the patient's condition.
Patients already on a treatment that's working are forced to switch medications, try the generic equivalent, and figure out a new regimen. Prior authorization rules already create yearly hurdles. Now, patients taking these drugs — and their providers — will have to go through complicated, time-consuming adjustments again.
These adjustments may be especially disruptive for patients on SSRIs, which are not interchangeable. Transitioning from one to another cannot be done overnight. Prescribers must tailor treatment plans to each patient, which takes time. Each additional treatment a patient tries can take weeks or months to evaluate, during which time patients are likely struggling with the impact of depression. Even if the new drug works, the patient has suffered for what CVS projects to be $130 in savings per person.
It's reasonable to favor cost-effective treatments such as generic drugs; patients and insurers can each save money from lower-cost prescriptions. But favoring generics is one thing. Blocking access to the brand-name version entirely is another. When a drug falls off a formulary, it can be all but impossible to access.
Though generic medications may work as well as brand-name for many — even most — people, there are always exceptions. For those exceptions, there must be a way for patients to access the original drug at the formulary price when necessary.
With psychiatric drugs, providers need all the flexibility they can get to help patients find the right treatment and get relief from symptoms of depression.
Under the best of circumstances, trial and error with medications takes time, costs money for everyone involved, and delays effective treatment for patients who are suffering. The process of navigating insurance bureaucracy — including authorization requests, denials and appeals — adds insult to injury. These costs are simply too high at a time the nation can least afford it.
Preserving access to remote mental health care
Some companies have increased roadblocks for telehealth services, another pandemic-era lifeline for people with mental health needs.
Early in the pandemic, many health insurers initially waived copays and other consumer costs for remote mental health visits. When mental health providers realized they could deliver good care remotely and patients embraced the convenience of tele-mental health, use of these services skyrocketed. Removing or reducing consumers' costs no doubt helped.
Though some insurers have committed to extending policies that encourage using telehealth, some have begun to reverse the waivers on consumer costs. Aetna, owned by CVS, extended its waiver of consumer costs on telehealth through January 31, 2021. When those waivers expire, many consumers will find themselves unable to pay for essential mental health visits.
As I've written before, making it harder to access telehealth — which is especially helpful for people with mental health needs — is the wrong approach. We need to expand telehealth, especially for patients with mental health needs, now more than ever.
Investing in mental health support
But it's not enough.
With a new administration in the White House and a new Congress sworn in, let's hope we have a new attitude toward — and investment in — mental health care.
President Biden proposed another $4 billion in mental health spending in his $1.9 trillion proposed rescue package. Biden campaigned on protecting the Affordable Care Act and improving access to mental health care.
After the insurrection of January 6, Biden again vowed to "restore the soul of our nation."
Now, he must lead the way toward securing the mental health and psychological well-being of the nation.