Medication Access and Continuity: The Experiences of Dual-Eligible Psychiatric Patients During the First 4 Months of the Medicare Prescription Drug Benefit

West, Joyce C.; Wilk, Joshua E.; Muszynski, Irvin L.; Rae, Donald S.; Rubio‐Stipec, Maritza; Alter, Carol L.; Narrow, William E.; Regier, Darrel A.

doi:10.1176/ajp.2007.164.5.789

Cited by 38 publications

(13 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, a survey of psychiatrists showed that while most psychiatrists (77%) would accept new self-pay patients, only 44% would accept a new Medicaid patient and this rate was even lower for psychiatrists who were white, board certified, or graduates of US medical schools (Wilk et al 2005). As an example of how a PBRN can respond to emerging policy changes, the PBRN was used to assess psychotropic medication access and continuity in the first 4 months of the implementation of Medicare Part D’s prescription drug benefit (West et al 2007). Psychiatrists reported that 10% of eligible patients seen by psychiatrists experienced improved medication access, but that 18% of medically stable patients were required to change medications, 22% discontinued or temporarily stopped taking a medication due to coverage or management issues, and that 27% of these patients experienced a significant clinical adverse event as a result.…”

Section: Pbrns Within Mental Healthmentioning

confidence: 99%

Revisiting Practice-Based Research Networks as a Platform for Mental Health Services Research

McMillen

Lenze

Hawley

et al. 2009

Adm Policy Ment Health

View full text Add to dashboard Cite

Practice-based research networks (PBRNs)—collaborations of practice settings that work together to generate research knowledge—are underused in mental health services research. This article proposes an agenda for mental health services research that uses a variety of PBRN structures and that focuses on what really happens in practice, the effectiveness of practice innovations in real world care, the challenges of implementing evidence supported interventions, modification of clinician behavior, and assessment of the effect of mental health policy changes on practice. The challenges of conducting research within PBRNs are substantial, including difficulties in maintaining positive member relations, securing ongoing funding, sustaining productivity, overcoming IRB entanglements and achieving both scientific excellence in recruitment and measurement validity and utility for practitioner members. However, the awareness of these challenges allows researchers and practitioners to build networks that creatively overcome them and that infuse mental health services research with heavy doses of the realities of everyday clinical practice.

show abstract

Section: Pbrns Within Mental Healthmentioning

confidence: 99%

Revisiting Practice-Based Research Networks as a Platform for Mental Health Services Research

McMillen

Lenze

Hawley

et al. 2009

Adm Policy Ment Health

View full text Add to dashboard Cite

show abstract

“…[25] In a small national survey of 908 psychiatrists, about 15% reported that their dual-eligible patients with mental illness had difficulties accessing refills or new psychiatric prescriptions and 8% had to switch psychiatric medications due to coverage restrictions during the transitional period. [26] …”

Section: Overall Effectmentioning

confidence: 99%

“…[42] In a 2006 national survey of 1,490 psychiatrists who treated dual-eligible psychiatric patients, utilization management strategies employed in Part D plans were associated with elevated risk of medication access problems, such as medication discontinuation or temporary termination, and adverse medical events. [26] …”

Section: Utilization Management Toolsmentioning

confidence: 99%

Medicare Part D and Quality of Prescription Medication Use in Older Adults

et al. 2011

View full text Add to dashboard Cite

In 2006, the United States Centers for Medicare and Medicaid Services implemented Medicare Part D to provide outpatient prescription drug insurance to disabled and older adults. In creating Part D, a key provision to address quality included medication therapy management (MTM) programs designed to increase proper and safe use of medications among targeted Part D beneficiaries. A preponderance of evidence shows that Part D has increased medication affordability and accessibility; however, what remains less clear is whether it has improved the quality of medication use and optimized health outcomes. Now in its sixth year, Part D is undergoing its first major revision with the gradual elimination of the coverage gap by 2020. Therefore, now is a good time to review the accumulated evidence on the impact of Part D and MTM programs on quality of medication use to help inform future policy decisions and research directions. In this review, we find that Part D’s net effect on quality of medication use mainly has been positive. Cost-related medication nonadherence improves moderately and treatment interruptions happen less than expected. However, vulnerable subgroups, such as sicker and dual-eligible beneficiaries, experienced lags in improvement. Beneficiaries who entered the coverage gap consistently experienced interruptions and displayed worsening medication adherence after entering the gap, with generic-only gap drug coverage offering only suggested limited benefit. Such findings can serve as baseline information as the coverage gap phases out. Limited availability of data is the biggest barrier to research in Part D. Part D’s overall effect on health outcomes and adverse medical events, such as hospitalizations, is inconclusive because of inadequate evidence to date. Similarly, no evaluation of quality of medication use is available on utilization management strategies and MTM programs delivered under Part D. Future research will need to further examine the added value of Part D and address whether it optimizes health outcomes in the Medicare population. As the current economic recession increases the pressure to cut costs, the effect of future spending restrictions, such as restrictions on coverage subsidies, will also be of special concern.

show abstract

“…These studies, conducted by the American Psychiatric Association’s (APA) Research Institute, provide an important look at the Part D program and its effect on dually-eligible beneficiaries with mental illness 7–10 . Psychiatrists have reported disruptions in access to medicine among dually-eligible beneficiaries, resulting in a troubling number of interactions with crisis services and inpatient hospitalizations 7 . Over 40 per cent of the dually-eligible patients reported on by their psychiatrists in these studies had experienced a medication access problem since the implementation of Part D.…”

Section: Literature Reviewmentioning

confidence: 99%

Roles of Community Helpers in Using the Medicare Part D Benefit

Hensley¹

2011

Journal of Health Care for the Poor and Underserved

View full text Add to dashboard Cite

Medication Access and Continuity: The Experiences of Dual-Eligible Psychiatric Patients During the First 4 Months of the Medicare Prescription Drug Benefit

Cited by 38 publications

References 22 publications

Revisiting Practice-Based Research Networks as a Platform for Mental Health Services Research

Revisiting Practice-Based Research Networks as a Platform for Mental Health Services Research

Medicare Part D and Quality of Prescription Medication Use in Older Adults

Roles of Community Helpers in Using the Medicare Part D Benefit

Contact Info

Product

Resources

About