Dual Eligibles Faced Serious Health Problems in Shift to Part D

Topic: Risk, prevention and care in population studies

The results were announced earlier this month at a press conference in Washington D.C., and were published in the May American Journal of Psychiatry.The rollout of the Part D program was plagued by widespread problems including reports that patients were being charged inappropriate copayments, pharmacies were unable to confirm eligibility in the program, and drug plans were failing to have transition policies in effect for the 6 million dual-eligible beneficiaries affected by the change."Even though policies were in place [to ensure that beneficiaries continued to have access to medications], prescription drug plans did not adhere to them," said James H. Scully Jr., M.D., APA medical director, at the press conference.So severe were the problems that by February of last year about half the states and Washington, D.C., had taken emergency action to continue prescription drug coverage under state financing until problems with the new federal program could be fixed (Psychiatric News, February 3, 2006).The APIRE study showed that the complaints were far from merely anecdotal as reported in the media at the time."This [study] is a realistic view of the problems that this extremely vulnerable population is facing in our public-financed systems of care," Darrell Regier, M.D., M.P.H., one of the study authors, told Psychiatric News before the study results were announced. "We know that it wasn't easy for these people to get their medications in the Medicaid program, but what this has demonstrated is that for these severely ill patients, [the switch to Part D] was not an improvement in terms of offering greater treatment accessibility.Minnesota psychiatrist Elizabeth Delesante, M.D., discusses her office's experience after Part D was rolled out on January 1, 2006.Credit: Sylvia Johnson"It was asking this population, many of whom have the added burden of cognitive impairment due to their illness, to negotiate an even more complex set of barriers to a managed pharmacy benefit to obtain their medications."For example, for many dual-eligible beneficiaries, even choosing a drug plan was fraught with complexity.Regier is director of the APA Division of Research and executive director of the American Psychiatric Institute for Research and Education (APIRE).Many of the medication access problems that the study identified in the first four months of the Part D program have persisted, at least throughout 2006, according to as-yet-unpublished data."We have continued to monitor

@article{daly2007-9745ef6e,
  author  = {Daly, Rich and Moran, Mark},
  title   = {{Dual Eligibles Faced Serious Health Problems in Shift to Part D}},
  journal = {Psychiatric News},
  year    = {2007},
  doi     = {10.1176/pn.42.10.0001a},
  url     = {https://doi.org/10.1176/pn.42.10.0001a}
}

Key findings

• The results were announced earlier this month at a press conference in Washington D.C., and were published in the May American Journal of Psychiatry.The rollout of the Part D program was plagued by widespread problems including reports that patients were being charged inappropriate copayments, pharmacies were unable to confirm eligibility in the program, and drug plans were failing to have transition policies in effect for the 6 million dual-eligible beneficiaries affected by the change."Even though policies were in place [to ensure that beneficiaries continued to have access to medications], prescription drug plans did not adhere to them," said James H.
• Scully Jr., M.D., APA medical director, at the press conference.So severe were the problems that by February of last year about half the states and Washington, D.C., had taken emergency action to continue prescription drug coverage under state financing until problems with the new federal program co
• The study does not prescribe a solution, but it does indicate that a solution needs to be found."Irvin "Sam" Muszynski, J.D., director of APA's Office of Healthcare Systems and Financing, said medication access under the Part D program is dependent on private insurance programs following the law and CMS guidance and not "changing the rules on a daily basis."
• Another concern is the overwhelmingly complex array of for-profit and other prescription drug plans associated with the original legislation's intent to privatize the management of this Medicare benefit.
• This is a condition that seems to guarantee a very chaotic and unregulatable system of access and utilization management, leading inevitably to decreased overall access and quality of care."Pollack is a professor of public policy in the departments of psychiatry and public health and preventive medicine at the Oregon Health and Science University.At the same time, Pollack cautioned against a "nostalgic longing" for the "good old days" of Medicaid coverage for prescription drugs for the psychiatrically ill dual-eligible population.

Why it matters

This study found that the rollout of Medicare Part D was plagued by widespread problems, including inappropriate copayments, pharmacies unable to confirm eligibility, and drug plans failing to follow transition policies. It reports that about half the states and Washington, D.C. took emergency action to continue prescription drug coverage under state financing.

Study details

• Evidence strengthLow

Read the original

• DOI: 10.1176/pn.42.10.0001a
• Original source →

May need a subscription OpenAlex found no free copy of the full text (checked 6 Feb 1020), so the publisher may charge for it.

Related studies in Health systems and care delivery

• Lawsuit Challenges Medicare Part D Transition Plan For Dual Eligibles Psychiatric News · 2005-12-16 · usefulness score 22/100
• Differential Effects by Mental Health Status of Filling the Medicare Part D Coverage Gap Medical Care · 2021-12-16 · usefulness score 36/100
• R WE ready for reimbursement? A round up of developments in real-world evidence relating to health technology assessment: part 19 Journal of comparative effectiveness research · 2025-05-12 · usefulness score 35/100
• R WE ready for reimbursement? A round-up of developments in real-world evidence relating to health technology assessment: part 25 Journal of comparative effectiveness research · 2026-04-16 · usefulness score 32/100
• Cultural shift Nursing older people · 2011-10-26 · usefulness score 38/100
• Outcomes for Dual-Eligible Beneficiaries With Dementia in Special Needs Plans and Other Medicare Advantage Plans JAMA Network Open · 2025-02-21 · usefulness score 53/100

Also in Health systems and care delivery

172 studies in the library are filed under Health systems and care delivery with no topic tag they share with another; these are this study's neighbours in a fixed tour of them. The Health systems and care delivery hub.

• Using a newly validated algorithm to estimate prevalence and incidence of Alzheimer’s Disease and related dementias in Medicare claims Alzheimer s & Dementia · 2023-12-01 · usefulness score 33/100 · Health systems and care delivery
• Coding Options for Central Auditory Processing ASHA Leader · 2002-05-01 · usefulness score 24/100 · Health systems and care delivery
• Disparities in High-Risk Medication Use—Implications for Health Equity and Deprescribing Practices JAMA Network Open · 2025-04-14 · usefulness score 36/100 · Health systems and care delivery

Similar studies

• Nationwide Availability of and Enrollment in Medicare and Medicaid Dual-Eligible Special Needs Plans With Exclusively Aligned Enrollment 2024 · Risk factors
• Discrimination, Stress, and Health Across the Life Course 2025 · Risk factors
• Disease-Specific Plan Switching Between Traditional Medicare and Medicare Advantage 2019 · Health systems and care delivery
• A National Examination Of Long-Term Care Setting, Outcomes, And Disparities Among Elderly Dual Eligibles 2019 · Disparities
• Diabetes and dementia: current data 2025 · Risk factors
• Chronic Disease and Disability in the United States: Trends, Inequities, and Imperatives for Policy Reform 2026 · Risk factors

More on Health systems and care delivery

• A review that covers this ground Rapid health technology assessment of galantamine for the treatment of Alzheimer's disease: A review Medicine · 2025-06-09 · usefulness score 52/100
• Newest in this subject Family physicians' attitudes toward people with dementia and their association with empathy Research Square · 2026-10-14 · Preprint — not yet peer-reviewed · usefulness score 16/100
• Newest in this subject Performance of Claims-based Alzheimer’s Disease and Related Dementias Algorithms in Medicare Advantage and Fee-for-Service Populations The Journals of Gerontology Series A · 2026-09-17 · Peer-reviewed · usefulness score 52/100

See all studies in Health systems and care delivery →