Guest Opinion: White House drug reform reversal leaves mental health patients pinching pennies

Published 8:47 am Saturday, August 10, 2019

By Patrick J. Kennedy

The White House just axed a proposal that would have made medicines more affordable for patients living with mental illness. Had the change taken effect, millions of Americans would have found it easier to afford the medicines they need.

I’ve made it my life’s mission to help Americans who are battling mental illnesses.

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While serving in the House of Representatives, I authored and co-sponsored bills to improve treatment of mental health disorders. And I’ve continued to advocate for these patients since leaving Congress.

Each year, millions of Americans confront mental illness. Roughly one in six Americans relies on some form of psychiatric medication.

Many patients struggle to afford the medications that keep them healthy. In 2017, nearly half of people battling a mental illness went without treatment, according to the U.S. Substance Abuse and Mental Health Services Administration. Almost half of those patients cited cost as the reason.

High out-of-pocket pharmacy bills deserve much of the blame. An analysis published in the Journal of the American Medical Association found that when copays for antidepressants double, patients fill 26 percent fewer prescriptions.

The Trump administration’s proposed rule would have reduced patients’ out-of-pocket costs. Specifically, the rule targeted third-party entities called pharmacy benefit managers.

Insurers hire PBMs to negotiate discounts with pharmaceutical companies. In recent years, PBMs have extracted ever-greater price concessions from drug makers. Total rebates grew from less than $70 billion in 2013 to $160 billion in 2018.

PBMs and insurers often use these discounts to reduce premiums. But they rarely use the savings to reduce patients’ out-of-pocket costs.

The president’s reform would have made it illegal for drug makers to give rebates to PBMs in government programs like Medicare and Medicaid, unless the PBMs and insurers used the rebates to reduce out-of-pocket costs.

This change would have driven down medical expenses for patients with government health insurance. Medicare beneficiaries were expected to save between $14 billion and $25 billion over the next decade.

Unfortunately, now that the Trump administration has withdrawn the rule, these patients will never see those savings.

For too many Americans, high out-of-pocket costs impede access to treatment. Abandoning this helpful reform was the wrong move.

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