Mental Health Part D News Alert

January 13, 2006

APA Expresses Concerns About Medicare Part D Prescription Program Impact on Patient Care

Arlington, Va. – The American Psychiatric Association (APA), the medical specialty society that represents more than 36,000 of the nation’s psychiatrists, is gravely concerned about the difficulties patients are encountering in attempting to obtain essential medications under the new Medicare prescription drug benefit, Medicare Part D.  This lack of access is jeopardizing the health and safety of countless numbers of patients.

The APA established an extensive monitoring system throughout the United States prior to the implementation of Medicare Part D, as a means of tracking difficulties experienced by patients and reporting them to the Centers for Medicare and Medicaid Services (CMS) and the prescription drug plans (PDPs) to have them remedied as they occurred. 

Over the past two weeks, prescriptions for many patients with mental illness (who received their medications through Medicaid prior to January 1) have not been filled.  Instead, efforts to obtain much needed medicine have been met with failures in the enrollment system, misapplications of deductibles, and miscalculations of co-pays.  The APA notes, that as of the release of this statement, 15 states (AR, CA, CT, HI, IL, MA, ME, NV, NH, NJ, ND, PA, RI, SD, VT) have already taken action to ensure that their citizens will continue to receive necessary medications despite the apparent breakdown in the delivery system of the new Medicare benefit.

The CMS instituted guidelines to guarantee that enrollees would have continued access to their medications under the new prescription drug program regardless of the plan in which they enrolled. 

The APA has reason to believe that CMS policies to ensure access to medications are not being met.  We believe these problems go well beyond mere technical difficulties. In fact, health plans are not adhering to the guidelines set up by CMS.  For example, they are not issuing emergency supplies and they have set up prohibited formulary restrictions.  Therefore, patients are leaving pharmacies without essential medications, the very thing CMS policies were established to prevent.

“The difficulty in transitioning from Medicaid to Medicare for prescription drugs is having a major impact on our patients with severe and persistent mental illnesses,” said APA President Steven S. Sharfstein, MD. “Relapse, re-hospitalization, and disruption of essential treatment are some of the consequences of this bureaucratic nightmare. I commend those states and other jurisdictions that have taken steps to assure that patients receive their medications in a timely manner.”

The APA supports CMS’s efforts to rapidly solve problems associated with this new program; problems that continue to hamper patients’ access to vital medications.  We urge CMS and the PDPs and their pharmacy networks to immediately take the steps necessary to guarantee that providers as following the policies for protecting continuity of care for patients. The APA remains ready to work with CMS, PDPs, pharmacies, physicians, and patients in any way to make sure this program fulfills promises to beneficiaries.

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Of note: The American Psychiatric Association (APA), in partnership with six other mental health organizations, launched a new Web site, www.MentalHealthPartD.org, to help psychiatrists understand and assist their patients in making decisions about the new Medicare prescription drug benefit.

About the American Psychiatric Association:
The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders.  Visit the APA at www.psych.org and www.healthyminds.org.