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:
"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
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. ▪