Seventeen percent of Americans are likely to suffer from a major depressive disorder during their lifetime.

It’s not hard to understand that the wide range of misery inflicted by widespread depression — broken families, unproductive workers — has serious implications for society as a whole.

That’s why advocates for years have been pushing for changes in insurance practices to treat psychological illness as seriously as physical ailments. They won a number of key victories in recent years, notably the Mental Health Parity and Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act, which requires most individual health plans to cover a range of mental health issues.

However, a new report suggests that some PPACA marketplace plans are not covering needed antidepressant medications. In a survey of 35 insurers participating on the exchanges in five states (Alabama, California, Florida, Maryland and Minnesota), the Robert Wood Foundation found that most plans excluded less than five antidepressants, but that several excluded more than a dozen antidepressant drugs from their formularies.

The PPACA requires all plans to cover the same number of drugs as are covered by the “benchmark” plan in their state, which is often simply the most enrolled small group health plan in the state. The law does not include the “protected classes” provision of Medicare, which requires plans to cover every drug in six designated medication classes, including antidepressants.

Perhaps the bigger issue the report revealed is how hard it is to find out whether a given plan covers a certain medication. Of the five state exchanges, only Florida and Alabama, which are run by the federal government, have links to the plan formularies that can be accessed by anonymously browsing for plans. However, even in those instances, the link often redirects a person to the home page of the insurance company’s website, which makes it hard to track down the needed information.

Furthermore, many plans do not include specific information on the variety of limits imposed on antidepressant coverage. Most require prior authorization, but some impose “quantity limits,” whose specifics are often not described on the plan formularies, the report found.

The report urges for more transparency on the exchange websites, as well as laws curtailing quantity limits and prior authorization requirements.

Instant Insights /

Some PPACA plans not covering important antidepressants

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