APA Undertakes Nationwide Study Of Medicare Part D Impact
APA wants to get hard data on what so far have been anecdotal reports about the Medicare prescription drug program's tumultuous beginning.
The American Psychiatric Institute on Research and Education (APIRE) is undertaking a national survey of psychiatrists to assess problems with continuity of care for psychiatric dual-eligible patients—those who until January 1 were covered by both Medicaid and Medicare—in the new Part D prescription drug program.
APIRE is also undertaking a parallel, 10-state study of medication access and continuity for psychiatric patients with only Medicaid insurance.
The overall goal is to monitor psychiatrists' practices with respect to the psychopharmacologic management of Medicaid and dual-eligible Medicaid and Medicare patients with mental and addictive illnesses, including:
Assessing access to medications and the extent of disruptions in medication continuity, | |||||
Characterizing adverse consequences that may result from unintended medication disruptions (e.g., symptom relapse or exacerbation, hospitalizations, increased functional impairment, homelessness, and injury to self or others), | |||||
Evaluating the administrative functioning and requirements of the new programs for clinicians and their staffs, | |||||
Identifying specific prescription drug plans (PDPs) or management mechanisms that appear to be functioning well or poorly to inform the development and implementation of future Medicare Part D PDPs. | |||||
“The transition to Medicare Part D has been quite rocky,” said APA President Steven Sharfstein, M.D. “We need to know what the impact is on our patients' access to essential treatment. This study will help see to what extent disruptions in care have led to poor outcomes for our patients.“
The survey will be an observational evaluation tracking patient and clinician experiences with medication continuity and access, throughout the implementation of Medicare Part D. Data collection will consist of three cross-sectional assessments conducted during the first nine months of Medicare Part D to capture effects of possible changes in PDP practices over time.
Key design issues of the Medicaid and Medicare PDPs in different states or regions will be assessed over time. This would include examining the relationship between medication continuity and key plan features such as preferred drug/formulary lists, prior authorization, “step therapy” or “fail-first” protocols, other management protocols such as automatically switching to generics, prohibiting benzodiazepines and off-label use of medications, dosing or number of medication limits, or time limits on transitioning patients to new medications.
The study focuses on two primary groups: dual-eligible patients and patients with Medicaid only. Some key patient outcome indicators include
Rates of problems accessing specific medications for new and continuing patients, including access to refills and “emergency” supplies, benzodiazepines, and off-label uses of medications, | |||||
Rates of clinically undesired medication switches or discontinuations, | |||||
Rates of symptom relapse or exacerbation, | |||||
Rates of hospitalizations, emergency room visits, and crisis mental health care, | |||||
Rates of injury to self or others, | |||||
Changes in housing status, | |||||
Changes in work and social functioning, | |||||
Changes in medication adherence and side effects. | |||||
Some key psychiatrist/practice outcome indicators would include administrative time spent by clinicians and their office staff in facilitating transition to the new Medicare Part D PDP plans and specific PDP prescription management and program administration features and their perceived impact—both positive and negative—on medication continuity and quality of care. ▪
