APA’s Government, Policy, and Advocacy Update (August 2023)

Psychiatrists and other physicians have reported that their patients are experiencing significant difficulties in accessing some medications, especially stimulants. The U.S. Food and Drug Administration (FDA) reported a stimulant shortage in October of last year that has persisted and, in some cases, worsened since then.

APA and the American Academy of Child and Adolescent Psychiatry (AACAP) sent letters to the FDA and the U.S. Drug Enforcement Administration, urging action on the drug shortages. Following a meeting with FDA officials, APA and AACAP have sent the agency additional questions about the shortage. Those questions include what can physicians and their patients expect in the next few months, how might new manufacturing plants impact stimulant supplies, and what can be done to prevent future shortages. APA expects a response from the FDA in the coming weeks.

Further, in July APA responded to a Congressional request for information from the House Energy and Commerce and Senate Finance committees regarding the increase in drug shortages. The letter, signed by APA CEO and Medical Director Saul Levin, M.D., M.P.A., included feedback from a recent poll of 465 APA members on the impact of drug shortages on patient care.

Ninety-nine percent of the poll respondents reported that their patients were struggling to access medically necessary prescriptions: 96% reported stimulant shortages, 12% reported benzodiazepine shortages, and 9% reported antipsychotic shortages. The letter outlined the challenges that patients and physicians experience, including pharmacy shopping, disruption in care continuity, and burdensome administrative processes. “APA encourages the federal agencies to deploy a coordinated response to the drug shortages,” Levin said in the letter.

In a letter to the Centers for Medicare and Medicaid Services (CMS), APA emphasized the importance of maintaining reimbursement for telehealth at equivalent rates to in-person care in the Medicare Physician Fee Schedule. The letter followed a meeting between APA staff and staff with CMS’s Hospital and Ambulatory Policy Group. In its letter, APA stated that a lower rate for telehealth services “is a significant risk to the increased access,” that CMS facilitated during the COVID-19 pandemic public health emergency.

The letter, signed by Levin, outlined some of the findings from APA’s 2023 Telepsychiatry Survey, which received 1,660 responses between March and April 2023. Some findings from this survey include the following:

“These findings demonstrate the importance of maintaining telepsychiatry reimbursement at rates equivalent with in-person care to maintain access to high-quality care for Medicare beneficiaries,” the letter stated.

Ten states have enacted laws based on APA’s model legislation for private insurance coverage of the psychiatric Collaborative Care Model (CoCM). The legislation requires insurers to reimburse for CoCM codes, a legislative solution that will improve access to evidence-based mental health care.

This year, Minnesota and Wyoming have enacted legislation initiated by the Minnesota Psychiatric Society and Wyoming Association of Psychiatric Physicians, respectively, into law.

APA State Government Affairs continues to support APA district branches and state associations in advocating for coverage of CoCM. ■