Posted by Phillipa on September 16, 2009, at 0:09:04
I didn't know this now Medicaid Patients must pay for Medicaire part D for medications for psychiatric conditions. So now co-pay where before no cost and it's leading to more ER visits. Phillipa
Switch to Part D Limits Access to Psychiatric Medications, Increases ED Use
Caroline Cassels
September 9, 2009 The switch from Medicaid drug coverage to Medicare Part D has restricted access to psychiatric medications and contributed to a subsequent high rate of emergency room visits among patients with mental health disorders, new research suggests.
A study conducted at Harvard Medical School in Boston, Massachusetts, shows that since January 2006, when the switch occurred, 44% of psychiatric patients reported difficulties in accessing medications. In addition, the likelihood of visiting an emergency department was significantly higher for psychiatric patients who experienced a medication access problem than for those who did not (odds ratio, 1.75; mean P = .003).
"We were surprised by the high rate of reports of access problems 44% of patients reported some type of access issue, and that's a pretty large number, even allowing for the fact that it is a relatively new initiative and you would expect a certain amount of miscommunication and confusion," lead author Haiden Huskamp, PhD, told Medscape Psychiatry.
The study is published in the September issue of Psychiatric Services.
Utilization Management
It is estimated that approximately one third of individuals dually eligible for Medicare and Medicaid benefits have a mental disorder. For these individuals, said Dr. Huskamp, pharmacotherapy is a key element of their treatment.
The authors point out that "dual eligibles" received coverage for prescription drugs through the Medicaid program in which patients paid little or none of the cost of their medications
However, under the Medicare Prescription Drug Improvement and Modernization Act of 2003, drug coverage for this population was shifted from Medicaid to the new Medicare Part D program, and all of these individuals were randomly assigned to a private Part D plan with associated premiums and other utilization management tools including prior authorization and stepped care.
"The creation of Part D represented an important switch for dually eligible patients. Now instead of getting their drugs from Medicaid, patients had to get their medications through private Part D plans, which had different coverage policies and restrictions," said Dr. Huskamp.
Dr. Huskamp added her group was particularly concerned about the potential effect of this policy change on the dually eligible psychiatric population.
"This is a particularly vulnerable population, and there was some concern that switching to a Part D plan that may have restrictions on the medications they were taking could have implications for the quality of care they received. So we wanted to look and see what was happening in this particular group," said Dr. Huskamp.
Drugs Not Covered or Approved
For the study, the researchers randomly sampled psychiatrists from the American Medical Association's Physicians Masterfile who reported on experiences of 1 dually eligible patient in the 9 to 12 months after Part D implementation.
Each psychiatrist was randomly assigned 1 of 21 start days and times to report on the next dually eligible patients treated during the psychiatrist's last typical work week. Information on patients' sociodemographics, treatment setting, diagnosis, clinical characteristics, and ability to access medication was gathered.
The researchers also obtained information on emergency department visits related to participants' psychiatric illness, as well as any psychiatric hospitalizations since January 1, 2006. A total of 908 patients were included in the final study sample. Of these 57% were women and 62% were between 41 and 64 years old. Almost two thirds had a diagnosis of either schizophrenia or bipolar disorder.
Overall, 400 individuals (44%) had some type of problem accessing their medications. Investigators found that 318 individuals (35%) were unable to access clinically indicated refills or new prescriptions because the drugs were not covered or approved.
In addition, 170 individuals (19%) were stable on a clinically desired or indicated medication but switched to a different drug because refills were not covered or approved, and 200 participants (22%) had problems accessing medications because of copayments.
Compared with a matched sample of dually eligible patients whose medication access was not disrupted, those with difficulty accessing their medication were more likely to incur a visit to the hospital emergency department related to their psychiatric illness.
It may be, said Dr. Huskamp, that switching from Medicaid to Part D had some unanticipated and unintended negative effects including the possibility of negative clinical outcomes, as indicated by a high rate of emergency room visits and increased health costs for non-drug-related health services.
"I think our study provides a red flag that some attention needs to be devoted to this issue. We need to examine the Part D data (which are currently not publicly available) so we can take a detailed look at utilization patterns and health outcomes for this population," said Dr. Huskamp.
"Certainly emergency department use is an indicator that things are not going well for patients, but having more concrete measures would be helpful to get a clearer understanding of how this policy change has affected patients' mental health status and functioning," she added.
poster:Phillipa
thread:917323
URL: http://www.dr-bob.org/babble/20090912/msgs/917323.html