Issue: Ensuring that individuals living with psychiatric disabilities have access to services and treatments is an essential component of achieving recovery from mental illness. While well-intentioned, some 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 – As part of the Medicare Modernization Act enacted in 2006, dual eligible individuals (those on both Medicaid and Medicare) must now get their prescription medications through Medicare. The state’s efforts to provide a ‘wrap-around’ benefit have proven effective at ensuring that those who face difficulties accessing medications are not denied their medications. However, the requirement that dual eligibles must pay co-payments to access medications under Medicare (which was previously not mandatory for those who couldn’t afford co-payments under Medicaid) is exceptionally onerous on some individuals and effectively prevents them from getting the medications they need to remain healthy and stable.

Preferred Drug Program – As part of the previously enacted Preferred Drug Program under Medicaid, safeguards were included to ensure that mental health medications would remain available to those who need them. In addition, physicians were guaranteed the final say regarding which medication their patient would be prescribed. Attempts in previous years to eliminate these safeguards were unsuccessful due to MHANYS and other’s advocacy.

Action:
Medicare Part D: 1) Provide permanent ‘wrap around’ Medicaid coverage for dual eligibles experiencing difficulties getting their medications from their Medicare Part D plan; 2) Cover co-payments for those dual eligibles unable to afford the mandatory co-payments required by Medicare.

Preferred Drug Program: Ensure that safeguards in the Preferred Drug Program remain to preserve open access to mental health medications and to retain the physician’s ability to make the final determination regarding medications prescribed to a Medicaid patient.