Government News
Congress Learns of Serious Part D Access Problems
Psychiatric News
Volume 42 Number 15 page 4-4

APA has told the House Ways and Means Subcommittee on Health that the government must do a better job protecting beneficiaries in the Medicare Part D program, especially "dual eligibles" with mental illness. Dual eligibles are those who qualify for both Medicaid and Medicare; their prescription coverage was shifted into Medicare Part D at the plan's onset at the start of 2006.

In written testimony submitted to the subcommittee, APA outlined the dramatic findings of a study by the American Psychiatric Institute for Research and Education (APIRE) of the troublesome effects of the transition from Medicaid to Part D on dual eligibles with mental illness.

The results of the first four months of that study were announced in May at a press conference in Washington, D.C., and published in the May American Journal of Psychiatry. Data from the remainder of the year were reported at APA's 2007 annual meeting in May (Psychiatric News, May 18 and July 20).

In the testimony delivered to the subcommittee on health last month, APA told representatives that more than half of the dual-eligible psychiatric patients studied had at least one problem with medication access or continuity since Part D began.

"These patients were not able to access medication refills or new prescriptions, or they discontinued or temporarily stopped their medications as a result of the changes in the coverage and management of prescription drug benefits," according to APA's testimony.

The testimony also highlighted these findings from the APIRE study:

"APA is deeply concerned that patients unable to access psychotropic medications will suffer serious consequences," the Association emphasized. "When mental disorders such as schizophrenia, bipolar disorder, or major depression are inadequately treated, the risk for loss of function, hospitalization, comorbid medical conditions, and mortality is substantially elevated."

APA urged Congress to work with the Centers for Medicare and Medicaid Services (CMS) to make the following changes:

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