Sending Office: Honorable James B. Renacci
Sent By:
Shane.Hand@mail.house.gov

Cosign Letter Urging HHS to Reduce Inappropriate Antipsychotics Prescribing to Seniors

Cosigners: Renacci, Larson, Clarke, Cleaver
 

Dear Colleague:

Please join us in writing to Health and Human Services Secretary Alex Azar regarding the inappropriate prescribing of antipsychotic drugs to seniors with dementia. While HHS has taken some steps to reduce inappropriate prescribing in nursing home settings,
little has been done to address the risks facing seniors in other care settings. Inappropriate use of antipsychotic drugs continues to be a concern in all settings, and we urge HHS to act now for the safety of our seniors.

To mitigate behavioral changes and mood swings associated with dementia, antipsychotic drugs are sometimes prescribed to seniors with dementia, despite these drugs not being FDA-approved for dementia-related behaviors and leading to increased mortality rates.
Despite this, Medicare Part D spends hundreds of millions of dollars on prescriptions for these drugs for adults with dementia.

HHS maintains and regularly updates a National Plan to Address Alzheimer’s Disease, which has included efforts to reduce the inappropriate prescribing of antipsychotics in nursing home settings. However, the various iterations of this plan have neglected
to address the nearly 14% of Part D beneficiaries with dementia who are being prescribed antipsychotics and reside outside of nursing homes.

Our letter requests information on what initiatives HHS currently operates to reduce unnecessary antipsychotics prescribing in alternative care settings in addition to its current nursing home endeavors. It also urges HHS to incorporate these alternative
care settings into future iterations of the National Plan and to continue its efforts in the nursing home setting.

If you are interested in joining as a cosigner, please contact Shane Hand (Shane.Hand@mail.house.gov) with Congressman Renacci’s office or Sylvia Lee (Sylvia.Lee@mail.house.gov)
with Congressman Larson’s office by Friday, September 28th.

Sincerely,

 

Jim Renacci                                                                             John B. Larson

Member of Congress                                                               Member of Congress

 

September XX, 2018

 

 

The Honorable Alex Azar
Secretary of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201

 

Dear Secretary Azar:

We write to you today regarding the Department of Health and Human Services’ (HHS) efforts to reduce inappropriate prescribing rates of antipsychotic drugs for seniors with dementia. While HHS has taken steps to reduce inappropriate prescribing rates for
nursing home residents, we remain concerned that these efforts are not fully addressing the problem in this setting. Additionally, we are concerned that HHS’s current efforts do little to address the risks facing seniors in alternative care settings.

Some individuals with dementia suffer severe changes in mood and personality, leading to agitation and aggression. To mitigate these behaviors, antipsychotic drugs are sometimes prescribed. While these drugs do have appropriate uses, their use for dementia-related
behaviors has not been approved by the Food and Drug Administration (FDA). In fact, in 2005, the FDA issued a public health advisory to alert consumers and providers that atypical antipsychotic drugs have been associated with increased mortality when used
to treat behavioral disorders in elderly patients with dementia. The FDA requires a black box warning for these medications. Despite this advisory, in 2012, the Medicare Part D program spent nearly $363 million for antipsychotic drugs prescribed for older
adult Medicare beneficiaries with dementia.[1]

The National Alzheimer’s Project Act requires the Secretary of HHS to report to Congress recommendations for priority actions to “improve the prevention, diagnosis, treatment, care, institutional-, home-, and community-based programs of Alzheimer’s disease
for individuals with Alzheimer’s disease and their caregivers.”[2] In response, HHS has launched several initiatives through its National Plan to Address Alzheimer’s Disease, to reduce inappropriate prescribing
rates of antipsychotic drugs among nursing home residents.

The risks posed to individuals by inappropriate prescribing of antipsychotic drugs are not confined to nursing homes, however. HHS’s recent National Plans to Address Alzheimer’s Disease do not address inappropriate prescribing rates of antipsychotics among
nearly 14 percent of Part D enrollees with dementia residing outside of a nursing home setting.[3] In 2015, the Government Accountability Office (GAO) recommended HHS expand its outreach and educational efforts
to reduce the prescribing of antipsychotics to older adults with dementia residing outside of nursing homes by updating the National Plan to Address Alzheimer’s Disease. HHS concurred with this recommendation in 2015, but neither the 2016 nor the 2017 plan
addressed this issue.[4]

Lastly, while HHS has taken steps to try and reduce inappropriate prescribing rates for nursing home residents, we are concerned there is still room for improvement. The 2015 GAO report noted that the use of antipsychotic drugs may be more prevalent in facilities
with staffing levels that are below what many experts would consider the minimum need to provide quality care.

Accordingly, we seek information on initiatives HHS currently operates to reduce unnecessary antipsychotic prescribing rates in older Medicare beneficiaries with dementia residing in and outside of the nursing home setting, and what the impact has been and
where improvements are still needed. We also urge HHS to incorporate an action plan to reduce the prescribing of antipsychotics in older Medicare beneficiaries that reside outside of the nursing home setting into its National Plan to Address Alzheimer’s Disease.

We look forward to your response.

Sincerely,

 


[1] Government Accountability Office. (2015).
Antipsychotic Drug Use: HHS Has Initiatives to Reduce Use Among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings
(GAO-15-211).

[2] https://www.gpo.gov/fdsys/pkg/BILLS-111s3036enr/pdf/BILLS-111s3036enr.pdf

[3] Government Accountability Office. (2015).
Antipsychotic Drug Use: HHS Has Initiatives to Reduce Use Among Older Adults in Nursing Homes, but Should Expand Efforts to Other Settings
(GAO-15-211).

[4] Ibid.

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