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By Stuart Isaacson, MD

Most all of us know someone living in a long-term care facility – a friend, a former neighbor, a family member. But not all may be aware of a recent debate about the use of a certain type of medication – antipsychotic medication – for seniors living in these facilities.

These medications are designed to treat mental illness. In recent years, however, it became evident that they were being misused, and overused, by long-term care facilities in an attempt to make some seniors easier for staff and family to manage. In response, the Centers for Medicare and Medicaid Services issued a rule last year designed to protect seniors. The rule requires
long-term care facilities that participate in Medicare and Medicaid to gradually reduce residents’ dose of antipsychotics.

Regulators acted responsibly. There’s just one problem: the dose reduction requirement isn’t appropriate for all long-term care residents. For some patients, such as those who suffer psychosis in conjunction with progressive conditions like Parkinson’s disease, the need for antipsychotic medications is ongoing.

To convey this issue to regulators, I joined 14 other health care providers who service patients living in long-term care facilities in authoring a letter to the Centers for Medicare and Medicaid Services. It outlined why patients with certain chronic conditions should be exempted from the requirement. Such a policy change, we argued, would accommodate medical innovation as FDA
approved new therapies like pimavanserin for the treatment of psychosis related to relentlessly progressive diseases.

Some of my colleagues at the Alliance for Patient Access had the opportunity to also speak with regulators about the realities of treating patients in long-term care facilities.

At a time when collaborative decision making about health care in Washington seems deeply improbable, what happened next was encouraging.

The Centers for Medicare and Medicaid Services released revisions to its rule and related evaluation criteria for long-term care facilities. The document specifies that reduction guidelines “are not intended to supplant the judgement of a physician or prescribing practitioner.” It also explains that “some residents with specific, enduring, progressive, or terminal conditions such
as chronic depression, Parkinson’s disease psychosis, or recurrent seizures may need specific types of psychotropic medications or other medications which affect brain activity indefinitely.”

This is good news for Parkinson’s patients and their families, who may rest assured that regulatory input will not stand in the way of what the physician deems best for his or her patient. It’s also a reminder that clinicians, advocates, and policymakers all want the same thing for patients: improved health outcomes and exemplary care. As a physician advocate, I am honored to have worked with federal regulators to create meaningful policy that reflects the
treatment needs of so many patients.

Stuart Isaacson, MD, is director of the Parkinson’s Disease and Movement Disorders Center of Boca Raton and associate professor of neurology at the FIU Herbert Wertheim College of Medicine. He is a member of the Alliance for Patient Access.

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