The Role of Medicare Part D in the treatment of Serious Mental Illness

Marisa Domino, Ph.D., Principal Investigator

Psychotropic medications are critical in the treatment of serious mental illness (SMI). New advances in psychopharmacological treatment have lead to substantial increases in the quality of life and functioning of persons living with schizophrenia, bipolar disorder, and major depressive disorder. Innovative treatment comes at a price, however, and expensive new psychotropic medications are often subject to cost control efforts like formularies and the use of prior authorization. Many individuals with SMI receive health insurance coverage through both Medicaid and Medicare due to the serious consequences these disorders have had on the ability to participate in productive private-sector employment.

Since January 2006, Medicare beneficiaries, including those with SMI, have had the opportunity to participate in a Medicare drug benefit (Part D) enabled by the Medicare Modernization Act of 2003 (MMA). This new benefit may have profound implications regarding access to and use of mental health treatments for all Medicare beneficiaries. No evidence is yet available documenting the experience of Medicare enrollees with these plans. In particular, the Medicare Part D drug benefit has substantially altered the access to drug treatments and financial incentives for care for full dually-eligible Medicaid/Medicare beneficiaries, those who qualify for Medicare and all Medicaid benefits. Those individuals received pharmaceutical coverage from state Medicaid programs prior to 2006 and were switched to the considerably more restrictive Medicare Part D coverage in 2006. The change in coverage is likely to disproportionately affect the mental health care of dually-eligible enrollees with SMI in ways that are not currently captured by the MMA debate.

To date we know little about the experience of individuals with SMI who are dually eligible for both Medicare and Medicaid. Medicare data to assess these changes will not be available until 2009. This information gap calls for creative approaches to assess the immediate impacts of the Part D changeover. The proposed research addresses this need. We will use North Carolina Medicaid claims and enrollment data from two years before the implementation of Medicare Part D to the first two years afterwards to provide timely evidence on the impact that Medicare Part D has had on dual eligible recipients with SMI. By understanding the impact of the Medicare drug benefit on the mental health care of Medicare beneficiaries we may better inform clinical and health policy decision makers. The potentially large uproar the new benefit design has caused in the treatment patterns and therefore quality of life for dual enrollees with mental illness gives urgency for a thorough analysis of this important issue.

Results from this study are critical in laying down a foundation of information on the influence of one of the most important changes in federal health policy in the US in decades on individuals with serious mental illness. While scientists have created the potential for vast improvements in functioning and quality of life for individuals with SMI through new psychopharmacological treatments, these advances cannot translate into actual human gains if barriers to the access of psychotropic medications remain.

This study is funded by an Independent Investigator Award from the National Alliance for Research on Schizophrenia and Depression (NARSAD).