Increases in Medicare prescription drug plan costs attributable to psychotropic medications.
OBJECTIVE
Older patients may regard some medications, particularly psychotropic medications, as discretionary compared with what they perceive as more "essential " nonpsychiatric medications. Patients' concerns about psychotropic medication costs under Medicare Part D may reinforce these impressions.


METHODS
The authors examined which Medicare prescription drug plans (PDPs) would be least expensive for beneficiaries considering the costs of 1) all medications; and 2) only nonpsychiatric medications.


METHODS
The authors collected data from the PDP online comparison tool provided by the Centers for Medicare and Medicaid Services (CMS).


METHODS
Hypothetical Medicare beneficiaries.


METHODS
The authors examined four clinical scenarios from older outpatients with both chronic medical and psychiatric conditions (including psychosis, bipolar disorder, depression, and dementia with behavioral disturbances).


RESULTS
The authors examined data from all 160 plans available in CMS PDP regions in May 2007. There were frequent discrepancies in the least expensive PDPs within region, depending on considering the costs of all medications, or just nonpsychiatric medications. In the clinical scenarios, patients selecting a PDP based on nonpsychiatric medications alone would pick an unnecessarily more expensive plan 74%-100% of the time (when they took any brand name medication), suggesting that excluding psychiatric medications from PDP choices may be excessively costly. However, brand name psychotropic medications significantly increased the costs of the least expensive plans. The latter finding might persuade patients to avoid taking needed psychiatric medication due to cost.


CONCLUSIONS
This research highlights the complexity that patients with psychiatric and cognitive disorders face when choosing a Medicare PDP. Policymakers and clinicians should be aware of the tradeoffs that beneficiaries with psychiatric disorders face when making PDP plan choices.
Zivin
Kara
K
Department of Veterans Affairs, Health Services Research and Development (HSR&D) Center of Excellence, Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI, USA. kzivin@umich.edu
McCammon
Ryan J
RJ
Davis
Matthew M
MM
Halasyamani
Lakshmi K
LK
Kales
Helen C
HC
D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000188:drug therapy / Q000191:economics; D003657:Decision Making; D003704:Dementia / Q000188:drug therapy / Q000191:economics; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics; D005252:Fees, Pharmaceutical; D005260:Female; D005382:Financing, Personal; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics*; D001523:Mental Disorders / Q000188:drug therapy* / Q000191:economics; D017059:Models, Econometric; D011618:Psychotic Disorders / Q000188:drug therapy / Q000191:economics; D011619:Psychotropic Drugs / Q000191:economics*; D014481:United States
D011619:Psychotropic Drugs