New APA Study Documents Problems With Medicare Part D Plans Restricting Access to Medications for Dual Eligibles With Mental Illness
May 1, 2007
At a press conference today, the American Psychiatric Association (APA) released a survey of psychiatrists with important new findings on how dual eligibles with mental illness are faring under the Medicare Part D drug benefit. Among the important findings in the study are that the psychiatrists surveyed in the study reported:
- About 1/3 of patients (30.6%) could not access needed medication refills in the early months of 2006 – despite requirements put in place by CMS (the federal agency that oversees Medicare) requiring Part D drug plans to make such refills,
- Medically necessary medications were terminated or interrupted for more than a fifth of patients (22.3%) because of plan formulary requirements,
- Changes to patient’s ongoing medication was mandated – apparently, for no other reason than cost – for about one in five patients (18.3%) who had been stable on their original medication.
The study also finds disturbing consequences resulting from the efforts of Part D prescription drug plans to restrict access to medications – often in violation of CMS requirements designed to ensure broad access to antipsychotics, antidepressants and anticonvulsants. The surveyed psychiatrists reported that among dual eligibles in their care:
- More than one-fifth of patients (21.7%) suffered an increase in suicidal behaviors or thoughts,
- Nearly one in five (19.8%) required an emergency room visit and more than one in ten (11%) required hospitalization.
It is important to note that this study reaffirms findings and positions that NAMI has advocated for more than two years:
- That it is critical for Part D drug plans to meet their obligation for broad coverage of medications to treat mental illness – specifically to cover “all or substantially all” of the medications in 6 classes, including antipsychotics, antidepressants and anticonvulsants – currently required by CMS. NAMI supports efforts to Congress to codify this requirement as part of the permanent Medicare law.
- Congress should change Part D to waive cost sharing for dual eligibles residing in board and care homes, psychiatric residential facilities and congregate living arrangements – as is proposed in S 1107, legislation proposed by Senators Gordon Smith (R-OR) and Jeff Bingaman (D-NM).
- Congress needs to amend Part D to allow for coverage of benzodiazepines which are currently excluded from coverage.