Coverage and prior authorization of psychotropic drugs under Medicare Part D

Psychiatr Serv. 2007 Mar;58(3):308-10. doi: 10.1176/ps.2007.58.3.308.

Abstract

This study examined formulary coverage and use of utilization management tools for three classes of psychotropic medications (antidepressants, antipsychotics, and anticonvulsants) among Medicare Part D prescription drug plans serving individuals dually eligible for the Medicare and Medicaid programs. Plans must cover "all or substantially all" molecules (distinct drugs) in these classes. Plans serving "dual eligibles" generally covered at least one formulation of all molecules in the three classes. However, certain product formulations were not covered by a number of plans, and use of prior authorization was common for a minority of plans. The effect of Part D will depend on the restrictiveness of the prior authorization and appeals processes, which is currently unknown.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Benchmarking / legislation & jurisprudence
  • Eligibility Determination*
  • Formularies as Topic*
  • Humans
  • Insurance Claim Review
  • Insurance, Pharmaceutical Services / legislation & jurisprudence*
  • Insurance, Pharmaceutical Services / statistics & numerical data
  • Medicaid / legislation & jurisprudence*
  • Medicaid / statistics & numerical data
  • Medicare Part B / legislation & jurisprudence*
  • Medicare Part B / statistics & numerical data
  • Mental Disorders / drug therapy*
  • Mental Disorders / economics
  • Psychotropic Drugs / economics
  • Psychotropic Drugs / therapeutic use*
  • United States

Substances

  • Psychotropic Drugs