Why Medicare pays so much for psychiatric drugs

“Never mind” said the Obama administration in March after its proposal to limit automatic Medicare coverage of pricey depression and psychiatric drugs was met with a Pharma funded backlash. It apparently wasn’t worth it as “patients” on the Hill yelled “You’re going to limit WHAT?” and won.

As private insurers balk at paying as much a month as $830 for Abilify, $250 for Seroquel, $450 for Geodon and $760 for Invega, Pharma increasingly relies on government programs to subsidize its expensive psychiatric drug habit. At least 16 states pursued legal action in 2008 against similar profiteering in Medicaid programs (which included Texas Medicaid paying $557,256 for two months of pediatric Geodon which was not even approved for children.)

That is no doubt why in February the Obama administration sought to limit the “protected status” of expensive categories of brand name pills which account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.

Siphoning expensive psychiatric drugs, many of which are unnecessary or have cheaper alternatives, through government programs has been Big Pharma’s marketing plan for over a decade. In Texas, a Medicaid “decision tree” called the Texas Medical Algorithm Project was instituted that literally requires doctors to prescribe the newest psychiatric drugs first. Ka-ching. It was—surprise—funded by the Johnson & Johnson linked Robert Wood Johnson Foundation.

Big Pharma also uses patient front groups to scream about the need for expensive drugs when alternative drugs exist. “When insurers balk at reimbursing patients for new prescription medications, these groups typically swing into action, rallying sufferers to appear before public and consumer panels, contact lawmakers, and provide media outlets a human face to attach to a cause,” writes Melissa Healy of the Los Angeles Times about their tactics.

Many of the groups have been probed by Congress for their undisclosed industry backing, including the Depression and Bipolar Support Alliance, which gets half its funding from Pharma; Mental Health America, the National Alliance for Research on Schizophrenia and Depression and the National Alliance on Mental Illness (NAMI).

NAMI, perhaps the best known group, received $23 million in just two years from Pharma and draws as much as 75 percent of its donations from drug companies. No wonder NAMI led the fight against Obama’s proposal, saying it “undermines a key protection for some of the sickest, most vulnerable Medicare beneficiaries.” NAMI lobbyist Andrew Sperling also said, “You get much better outcomes when a doctor can work with patients to figure out which medications will work best for them,” in a plug for drugs which happen to cost several hundred dollars a prescription.

The issue is not just Pharma looting taxpayer dollars. Many of the newer psychiatric drugs are not better than the older, less expensive drugs and are actually less safe. One chilling example is the overuse of deadly antipsychotic drugs in nursing homes. An estimated 15,000 nursing home residents die each year , FDA drug reviewer David Graham, MD, told a congressional panel in 2007, from inappropriately given antipsychotic medications! Antipsychotics like Seroquel carry warnings that they cause death in elderly people who have dementia but are nevertheless in wide use in many geriatric, federally-supported facilities. So much for “patient choice.” So much for NAMI’s concern for “the sickest, most vulnerable Medicare beneficiaries.

Martha Rosenberg is an investigative health reporter. She is the author of Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).

5 Responses to Why Medicare pays so much for psychiatric drugs

  1. “Never mind” indeed. Standard operating procedure for Obomber. Make a little noise about fighting for what’s right (this time, limiting coverage of pricey, mostly dangerous and unnecesary psych drugs) and then surrendering to the corporate beast. Big Pharma literally wrote Obominable Care Act; feckless Obomber isn’t about to do a darn thing to stop the drug companies’ onward march to loot the Treasury.

  2. Yes it really is funny how dilemmas similar to this one start looking amazingly trivial compared to the world events. Another chapter of the cold-war, the actual authentic war that erupts, Russia-China fuel offer axis… Nonetheless here we’re with our social-media issues, – can we notice the globe has transformed? Iam not saying everything you come up with is unimportant, Iam declaring that a certain amount of detachment is healthy. Thanks, Sarah

  3. If a patient is already on a drug, switching them to a generic version of the same drug isn’t safe because the generics have the dosages only within about 20% error (Consumer Reports). This is too big an error for psych drugs. If they are on generics already, they need to make sure they always get the same generic from the same manufacturer. Cheaper, older drugs are a better bet, I mean really old ones like Lithium and MAO inhibitors. Also, there is no need to use such huge dosages of drugs. The drugs are often prescribed at dosages way above anything that’s safe or approved. This is harmful to the patient, and is not necessary to say the least. Even the standard dosages are probably unnecessarily high. Lithium can be used in 10% of the standard dose with the same therapeutic effect (but not the same damage to organs and the cardiovascular system). I wonder how many other drugs that is true of. Drugs should not be reimubursed for off-label uses or for dosages above what is clearly safe and approved. Off-label drugs should not be able to be forced on patients; this includes ALL off-label prescribing to children (children cannot consent to drugs any more than they can consent to sex). That should simply be a crime, on top of not being reimbursible. Antipsychotics should not be able to be prescribed for dementia, for annoying behaviors, etc. Ultimately we need to focus on putting more Medicare and Medicaid money into mental health modalities other than drugs, to reduce drug dependence. This especially includes PEOPLE-intensive modalities, such as community skills workers, tutors and child mental health mentors, Open Dialogue, hearing voices support groups, better staff to patient ratios in hospitals, psychotherapists, lifestyle coaches, peer support programs, etc. Drugs are being used as a substitute for human attention, just like automation is used to replace humans in manufacturing. Drugs are not a substitute for human relationships. Dependency on dangerous and harmful substances isn’t “recovery.” It is rare (about 3%) for patients to have any “benefit” from them. There are the very few who can give those testimonials, and public policy should not be based on them. Oh- those patients die young, too, just like the rest of them. The drugs are killing people much younger than they would otherwise die. There are other ways to improve mental health, that bring about greater and more lasting improvement, and that don’t cause such huge horrible medical problems (that lead to death). They involve human relationships. They involve training, and paying wages to, actual humans. People-intensive modalities work, including for serious mental illness involving psychosis. If they are actually provided, which is rarely done adequately. We are not providing the people-intensive modalities, the people with mental health issues are having a hard time, and then government and media are jumping on the bandwagon, “we need to force drugs on these people.” Not really. We need to train and pay wages to humans who can provide the needed care that is missing. There isn’t sufficient Medicaid or Medicare or any other funding, going toward that.

  4. ELois P. Clayton

    ATTN: It is hard for I to believe that our current president(O’Bama), is intentionally underminding health.
    I believe that it is more like the individuals who has been put “in charge”, is underminding what they were hired for(which makes our president appear to be responsible for these atrocities)!

    ATTN: It amazing (but not really), that MORE of the so-called “professionals”, are being EXPOSED and PROSECUTED, for THEIR roles in these corruptions(which our president had NO knowledge of these harriffic events happening to our lovedones, which has caused death, illnesses and CIVIL lawsuits)(which obviously is being proven by doctors like Dr. Paul Breggin, that it’s ‘Big Pharma”, who behond these corrupt activities)!

    ATTN: Our president(of the U.S.;currently), is not responsible for the GREED that exist in this country!

    ALERT! I PRAY(daily), that MORE individuals (like Dr. BREGGIN), come forward with COURAGE and support his works of ridding these corrupt “professionals”(who are harming our lovedones health)!

    ATTN: AGAIN (I stress) that not enough is being focused on the ABUSES that has been in existance at Chester MHC, in Chester, Illinois(and has never been exposed enough).
    It’s time for a RALLY to take place at Chester MHC(just as one took place for rodenyyoder,.com), before he was released from Chester in 2005(after his case of abuses were proven by his attorney(as Dr. BREGGIN has proven for his clients about psych drugs)!

    ALERT! I don’t want my brother to wound up in that CEMETERY located about (5) minutes SOUTH of CMHC(where 24 patients are buried near the water), from being administered/FORCED psychotropic drugs by CMHC administrators “treatment teams.”
    “PLEASE SEND HELP” is the message rodneyyoder.com sent in his quest for release from Chester and we(David’s family), is sending the same message for our David!

    ATTN: I can be contacted(with medical records proofs/photos of injuries done to our David(by no fault of his), along with FOIA PHONE RECORDS, that Chester employees(starting with the admins.)has been involved in the COVER UP of ABUSES on David(and I’m sure other vunerable patients at Chester), for YEARS!

    MY PHONE NUMBER IS, (773)826-2591.
    Thank you.
    Mrs. E.P.Clayton
    (sis. of David P.)

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