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Medicare Part D Made Easier

James H. Scully Jr., M.D., is medical director and CEO of APA.

The odds are that the majority of beneficiaries attempting to take advantage of the prescription drug coverage that will take effect January 1, 2006, will need help. Their physicians and family members are already being called on. Many of you have called on APA. We are here to help.

Confusion arises because there are important choices to make with imperfect information. Beneficiaries wonder, Should I enroll? Which plan should I enroll in? What medications are covered? Some things, however, are clear:

• Many beneficiaries will save money and may enjoy greater access to needed prescription drugs.
  
• The needs of regular Medicare beneficiaries will differ from those who are dually eligible for Medicare and Medicaid. Dual eligibles, for example, are already being enrolled automatically, and randomly, into the lower cost plans in their area—plans that may not be optimal for them because of formulary or other limits to access.
  
• Regular Medicare beneficiaries face this warning from the Centers for Medicare and Medicaid Services (CMS): "If you don't sign up when you are first eligible or by May 15, 2006, you may pay a penalty. Your next opportunity to enroll is from November 15, 2006, to December 31, 2006."
  

A successful enrollment and plan choice, then, will accrue to those beneficiaries who gather as much relevant information as thoroughly and promptly as possible. In addition, it certainly will help patients to be prescient and lucky as part of their task is to guess their future medication needs.

Medicare offers a "plan finder" on its Web site at <www.medicare.gov> to assist. APA has reviewed this tool and has found it to be improving slowly such that, today, it is reasonably helpful for patients. Because the tool is ZIP code- and patient ID-dependent, it is less useful to practitioners, who will find it particularly burdensome if they are trying to help multiple patients with formulary concerns. Most everyone who has tested the plan finder says that it is cumbersome and slow.

APA believes a more useful tool for psychiatrists is a comprehensive list of what medications are covered by each plan—information that we are actively seeking from CMS but without success to date.

Additionally, to help both psychiatrists and patients, APA and seven partner organizations have launched a new Web site at < www.MentalHealthPartD.org>. (A link to the site is on APA's homepage at <www.psych.org> and our consumer information site at <HealthyMinds.org>.) Importantly, the Part D site has a section specifically for patients, so they can seek out answers independently.

Topics covered on <www.MentalHealthPartD.org> of interest to psychiatrists include:

• Enrollment and eligibility for the new benefit
  
• Patient costs and subsidies
  
• Drug formularies and coverage determinations, exceptions, and appeals
  
• Continuity of care
  

I believe you will find it a useful Web site, giving you a way to help patients and families help themselves more easily access indispensable information. The site will be updated regularly, especially as new facts and material emerge from CMS. APA and our partners have aggressively pursued more complete information from CMS, a process that has proved arduous and oftentimes fruitless.

This vital advocacy and the <MentalHealthPartD.org> site are the work of APA's Office of Healthcare Systems and Financing, under the leadership of Irvin "Sam" Muszynski, and a coalition that includes the American Association of Community Psychiatrists, American Association for Geriatric Psychiatry, National Alliance on Mental Illness, National Association of State Mental Health Program Directors, National Council for Community Behavioral Healthcare, National Mental Health Association and Treatment Effectiveness Now project.

The Medicare Part D benefit is so complex that APA has dedicated substantial time and resources, including much coverage in Psychiatric News, to educating members about it. But the more difficult job is explaining it during a routine patient visit. Your APA stands ready to assist you.

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