The Medicare Evidence Development and Coverage Advisory Committee on Wednesday will discuss and vote on the definition of treatment-resistant depression and advise the CMS on coverage.
But mental health trade groups and Medicare beneficiary advocates don't know why the CMS felt the need to convene MEDCAC to discuss the issue. None could point to any major-related concerns.
A CMS spokesman did not immediately respond to a request for comment.
What is clear is that 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. An estimated 7 million American adults over age 65 experience depression, according to the Centers for Disease Control and Prevention.
A common medical definition for treatment-resistant depression is this: cases of major depressive disorder that do not respond adequately to courses of at least two antidepressants. Electric convulsive therapy (ECT), which cost Medicare $320 per treatment in 2016, is one alternative if drugs fail.
About eight ECT treatments are needed to obtain results.
Medicare beneficiaries with serious mental illnesses or alcohol- and drug-related problems may be treated in inpatient psychiatric facilities (IPFs), either free-standing hospitals or specialized hospital-based units, according to the Medicare Payment Advisory Commission.
On average, Medicare beneficiaries account for about 24% of psychiatric facilities' discharges, MedPAC says. The CMS paid IPFs an estimated $4.3 billion in 2013, slightly down from $4.4 billion the prior year. Those are the most recent numbers available.
In MedPAC's March 2016 report to Congress, a beneficiary study performed in 2013 found that only 13% with a behavioral health condition had trouble getting the care they needed.
The National Alliance on Mental Illness will be speaking at Wednesday's event. Officials say they want to be sure 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, said Andrew Sperling, director of legislative affairs for NAMI, though 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, they often follow MEDCAC's suggestions.
The panel will meet just days after the CDC released data on the latest year's suicide statistics. There were nearly 43,000 U.S. suicides in 2014.