Dual Eligibles with Mental Disorders and Medicare Part D

In 2006, 6 million beneficiaries who were eligible for both Medicare and Medicaid switched from Medicaid to Medicare Part D for coverage of their prescription drugs. This change led to an expanded role for Medicare in financing psychotropic medications for dual eligibles. A reduction in the number of plans serving these beneficiaries and an increase in utilization restrictions for some psychotropics since 2006 raise concerns about access to medications for dual eligibles with mental disorders and point to potential problems with adverse selection. To improve access for this population, Medicare might consider changes to its enrollment and risk-sharing systems.

In this paper, the authors assess how dual eligibles with mental disorders are faring under Part D. They go on to further describe how payment for psychotropic medications for this population has changed as a result of Part D; providing background on the Part D market for dual eligibles, which presents a more complicated set of choices for these enrollees than what they faced under Medicaid; and describe the policies put into place by Medicare to ensure access to medications for this vulnerable population.