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Volume 12 Number 84 News: Part D Drug Benefit Patients in the Medicare drug benefit who take medications for mental illnesses are unable to get full access to prescription drugs prescribed by their physicians and are suffering health consequences as a result, according to a study released May 1 by the American Psychiatric Association. The study focused on the experiences of dually eligible beneficiaries (those who qualify for coverage under both Medicare and Medicaid), and found that more than half who were being treated for psychiatric conditions reported at least one problem accessing their medications during the first 120 days of the benefit. The study, Medication Access and Continuity: The Experiences of Dual-Eligible Psychiatric Patients During the First Four Months of the Medicare Prescription Drug Benefit, was conducted by the American Psychiatric Institute for Research and Education (APIRE), and appears in the May issue of the American Journal of Psychiatry. About 2 million of the 6 million dual-eligible beneficiaries enrolled in Medicare Part D drug benefit plans have mental illnesses, APIRE Executive Director Darrel A. Regier said at a briefing on the study. No Compliance Although the mental health community and the Centers for Medicare & Medicaid Services anticipated some implementation-related disruptions in coverage for psychiatric patients, plans have not complied with CMS guidance designed to prevent switching of stable patients to new drugs and to ensure access to the six protected classes of drugs, Regier said. He said the study found that 18 percent of previously stable mental health patients were required to switch medications, and that 22 percent discontinued or temporarily stopped medications because of changes in how they obtained their drugs. In addition, the study found that 27 percent of all mental health patients had prescription drug exceptions filed on their behalf, but that 18 percent changed or discontinued clinically indicated medications, rather than pursue exceptions or appeals. Regier said that among the most alarming findings were that 20 percent of patients who encountered access problems for mental health medications had emergency room visits. Likewise, he said, 22 percent had an increase in suicidal ideation or behavior and 15 percent had an increase in violent ideation or behavior. Early in Benefit, but Problems Persist The study was limited to the first four months of the Part D benefit, which was launched in January 2006. However, Regier and others said the problems persist today. Researchers are continuing to analyze data from later in the 2006 plan year, and will issue findings in the future, Regier said. "It wasn't working in January '06 and it's not working in May '07," Minnesota psychiatrist Elizabeth V. Delesante said at the briefing. She said that none of her dually eligible patients were able to get their prescribed medications on the first attempt, and that she and other practitioners are frustrated by the lack of timely response by plans to requests for exceptions and appeals. In addition, she said, previously stable mental health patients who have problems accessing needed medications can end up hospitalized and requiring increased doses of medications to restabilize. That is a problem for patients and their caregivers and costs the Medicare program more money. APIRE researcher Joyce West agreed that the medication access problems for psychiatric patients was not limited to the Part D implementation, but was a systemic problem. West said she had expected to see the access problems decline later in 2006. Instead, she said, problems have persisted at the same levels. Unenforceable Guidance American Psychiatric Association Director Irvin L. Muszynski said that CMS has provided guidance to plans to address the problem, but that the mental health community is relying on plans to voluntarily comply. He noted that the guidance issue of particular concern in light of a January 2007 Office of Management and Budget policy statement that called informal agency guidance unenforceable. In an April 26 open letter to plans, APA Medical Director and Chief Executive Officer James H. Scully Jr. asked insurers to adhere to the CMS's formulary guidance that would ensure access to medications to treat mental illness as prescribed by beneficiaries' doctors. "Prescription Drug Providers have a key role in ensuring patients' well-being, by providing them with access to the medications their physicians have prescribed," Scully said in the letter. "The APA urges, for the public good, that all Medicare Part D prescription drug plans ensure they are in full compliance with the CMS formulary guidelines."
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