Issue: Ensuring that individuals living with mental illness have access to services and treatments is an essential component of achieving recovery from mental illness. While well-intentioned, many government proposals and actions effectively restrict access to the services and treatments that allow individuals living with mental health needs to remain healthy and stable, especially with regard to medications.

Medicare Part D: Of particular concern are the difficulties individuals on both Medicaid and Medicare (dual eligibles) are facing attempting to get the medications they need to remain healthy and stable under the new Medicare Prescription Drug Benefit (Medicare Part D).

Preferred Drug Program: In addition, the Governor’s budget proposal calls for elimination of safeguards that allow the doctor to make the final decision about which medications a patient gets, and the consideration of cost in determining which drugs become ‘preferred’ (which would certainly impact the rather expensive mental health drugs) under Medicaid’s Preferred Drug Program.

Action:
Medicare Part D: 1) Provide permanent “wrap around” Medicaid coverage for dual eligibles unable to get their medications from their Medicare Part D plan; 2) Cover co-payments for those dual eligibles unable to afford the now-mandatory co-payments required by Medicare Part D

Preferred Drug Program: 1) Reject the Governor’s proposal to eliminate the “physician prevailing” language from Medicaid’s Preferred Drug Program; 2) Reject the Governor’s proposal that would allow cost to be used as a consideration of which drugs are deemed “preferred.”