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