Policy Implications of Medicare Part D for Adults With Mental Illness: A Qualitative Exploration

Abstract

The Medicare prescription drug benefit, introduced in January 2006, has had a substantial impact on the lives of adults disabled by mental illness. However, few studies have undertaken an exploration of the difference that this benefit has made to beneficiaries' access to medication. This study uses a qualitative approach to examine beneficiaries' experiences with the Medicare Part D benefit, and whether having Medicare prescription drug coverage is perceived as helpful. Twenty-six Medicare beneficiaries with mental illness were interviewed regarding their opinions of the Part D benefit, and the investigator found that most beneficiaries were highly satisfied with their prescription drug coverage. However, they would appreciate more information from the Medicare program about their benefits. In addition, beneficiaries were concerned about the possibility of increased future costs. Overall, however, these participants in the Medicare Part D program who had mental illness felt that their needs for psychotropic and other medications were met.

Medicare Part D's Effects on Drug Utilization and Out‐of‐Pocket Costs: A Systematic Review

“…The few studies on this population found mixed outcomes, which could be due to the small and nonrepresentative samples (Millett et al. ; Hensley ). Future research with representative samples is needed to evaluate effects on dual‐eligibles with various health conditions and level of prescription drug spending.…”

“…), dual‐eligibles did not have higher OOP costs. A qualitative study of adults with mental illness found mixed perceptions about the impact on OOP costs, with some interviewees expressing that Medicare Part D premiums and copayments were reasonable, while others revealing them to be a significant burden preventing them from obtaining other necessities (Hensley ).…”

“…There is some evidence that elderly dual-eligibles did not experience changes in pill-days, total number of prescriptions (Basu, Yin, and Alexander 2010), or medication access (Domino and Farley 2010). A qualitative study (Hensley 2012) of elderly dual-eligibles with mental illness reported that beneficiaries did not experience access problems during the transition and their needs for psychotropic and other medications were met. However, nonelderly disabled dual enrollees with mental illness experienced differential antipsychotic treatments depending on whether they lived in strict-cap (low limits on monthly fills) or no-cap states: post-Part D use of medications to treat schizophrenia (17.69 percent) and bipolar disorder (35.47 percent) increased disproportionately in strict-cap states (Madden et al 2015).…”

“…Two quantitative studies (Basu, Yin, and Alexander 2010;Millett et al 2010) and one qualitative study (Hensley 2012) found mixed outcomes or no significant changes in OOP costs among dual-eligibles (see Table 5). Compared to near-elderly patients with Medicaid coverage (Basu, Yin, and Alexander 2010) or elderly beneficiaries with previous coverage through Medicaid (Millett et al 2010), dual-eligibles did not have higher OOP costs.…”

Is 50 cent the price of the optimal copayment? - a qualitative study of patient opinions and attitudes in response to a 50 cent charge on prescription drugs in a publicly funded health system in Ireland

“…Furthermore, an increase in this copayment in 2005 led to decreased dispensings of some essential drugs; an unwanted feature of a limited copayment policy [23]. Some American qualitative studies have been carried out, however, they were focused on the logistical challenges that patients were faced with when Medicare Part D was established,[24] concentrated on how patients managed their medicines when taking multiple drug regimens [25] or were concerned solely with the opinions of mental health patients [26]. Even though there is an extensive literature available on the quantitative effects of copayments, and how this varies according to price paid and medicines used, there is a limited qualitative literature on examining public attitudes to small copayments.…”