Medicare Monday: The downside of one-size-fits-all treatment for patients managing mental health conditions

In the last couple weeks, we’ve compared the potential impact of using one-size-fits-all standards of care instead of personalized treatment plans for patients with breast cancer and colon cancer. In both case studies, the patients’ quality of life and long-term prognosis were compromised when decisions were made on an average rather than on the individual.

Mental health advocates have raised concerns about these tradeoffs with the government’s proposed changes to Medicare Part B. The National Alliance on Mental Illness stated in its comment letter to the administration, “Average assessments fail to consider differences in patient outcomes, needs and preferences and do not recognize the unique nature and value of targeted therapies that benefit specific groups of beneficiaries, including people with disabilities, complex conditions and multiple chronic conditions. No single patient is average.”

Our newest case study illustrates how the Medicare Part B Drug Payment Model could hurt care quality and outcomes for mental health patients by driving toward one-size-fits-all treatments. For Susan, a patient living with schizophrenia, her course of treatment makes the difference between being able to work or not.

(Click here for Susan's full profile.)

Other mental health advocates also highlighted the need for a range of treatment options for patients managing mental health conditions:

• The National Council for Behavioral Health said, “Without access to a full range of treatment options – including long-acting injectable medications – Americans living with serious mental illnesses and additions will never be able to benefit from advances in medical science that help them lead a fully functioning life in recovery.”
• Mental Health America noted, “finding the right medication is often a difficult process of trial and error.”
• And American Foundation for Suicide Prevention said the proposal, “will undermine our nation’s senior’s access to medication.”

For other case studies like Susan, visit PhRMA.org/casestudy, and a PDF of Susan’s profile is available here.

Learn more at PhRMA.org/PartB.