Impact of Transition from Medicaid to Medicare Part D for those with Serious Mental Illness

The HPHC Institute is one of the first to examine the impact of the transition from Medicaid to Medicare Part D in mentally ill populations in a study published in the Journal of the American Medical Association Psychiatry.

The study performed time-series analysis for patients spanning 2004 – 2007, comparing states that capped monthly prescription fills to states with no prescription limits.  Researchers considered Medicaid and Medicare claims for 9,229 patients who lived in the community, were under 65 years old, disabled, enrolled in both Medicaid and Medicare, and who had schizophrenia or bipolar disorder. 

Results demonstrated that effects on the use of essential and sometimes lifesaving psychiatric drugs for patients with schizophrenia or bipolar disorder varied greatly by state. Patients transitioning from Medicaid to Medicare Part D in states with strict limits on coverage experienced increased access to treatment, while those transitioning from states with more generous coverage saw reduced access, to antipsychotics in particular. Given that most states in the United States offer the more generous Medicaid drug coverage, the authors also found reductions in antipsychotic use nation-wide.

 According to first author and DPM researcher Jeanne Madden, PhD, the study highlights the impact of different state Medicaid policies regarding prescription coverage, and suggests the potentially harmful effects of cost shifting strategies sometimes used in Medicare prescription coverage for these patients.

Click here to access the abstract published online January 14, 2015.