Persons with mental disorders switching from Medicaid to Medicare drug coverage may have drug access problems
Research Activities, January 2010, No. 353
Low-income elderly persons and those with disabilities qualify to receive health insurance coverage from both Medicare and State-run Medicaid programs. Called "dual eligibles," these individuals were required to transfer their prescription drug coverage from Medicaid to Medicare Part D drug plans in 2006. Today, dual eligibles represent 29 percent of Medicare Part D recipients. Agency for Healthcare Research and Quality (AHRQ) researcher Samuel H. Zuvekas, Ph.D., and colleagues investigated how these changes in drug coverage affected dual eligibles with mental disorders. Although this vulnerable population has experienced little change in out-of-pocket drug costs for psychiatric medications as a result of the coverage switch, potential access problems may be emerging.
The researchers used data from the Medical Expenditure Panel Survey in 2005 and 2006 to determine the distribution of expenditures by payer for antidepressants, antipsychotics, and anticonvulsants. In 2005, Medicaid covered 14 percent, 55 percent, and 33 percent of all drug spending for these categories, respectively. In 2006, when six million dual eligibles switched to Medicare Part D, Medicaid's share of all drug spending was cut roughly in half for these psychotropic drug classes (8, 26, and 19 percent, respectively). In turn, Medicare's share of spending increased from 2 percent to 16 percent for antidepressants, 1 percent to 21 percent for antipsychotics, and 3 percent to 20 percent for all drugs from 2005 to 2006. By 2006, psychotropic medications became the second most costly drug category used by Medicare beneficiaries overall. They were also the most costly drugs among dual eligibles.
The researchers also noted that Medicare Part D drug plans are using more utilization management requirements to curb costs since 2006. They caution that prior authorization and step therapy (where less costly drugs must be used first) may lead to medication access problems and even discontinuations for dual eligibles with mental disorders. Finally, these individuals may be adversely affected by prescription drug plans that have exited the market. Dual eligibles may be placed into new plans with different requirements that could affect access to and continuity of treatment.
More details are in "Dual eligibles with mental disorders and Medicare Part D: How are they faring?" by Dr. Zuvekas, Julie M. Donohue, Ph.D., and Haiden A. Huskamp, Ph.D., in the May/June 2009 Health Affairs 28(3), pp. 746-759. Reprints (AHRQ Publication No. 09-R062) are available from the AHRQ Publications Clearinghouse.