From the Administrator: Maximizing the Benefit of Medicare
is a saying: All people are in favor of progress; it's
the change that they don't like. We are poised at a time
of tremendous change now, as the Federal Government moves
forward with the Medicare Prescription Drug, Improvement,
and Modernization Act of 2003.
This landmark act offers new opportunities for the 42
million Americans with Medicareincluding people
with mental and substance use disorders. In particular,
the January 2006 launch of the new Medicare Prescription
Drug Coverage will provide many people with prescription
drug coverage for the first time. (See SAMHSA News
cover story Medicare Modernization
Brings Big Changes.)
We recognize that the changes to the 40-year-old Medicare
program also present challenges for people with mental
and addictive disorders. In particular, the transition
carries special considerations for those who have both
Medicare and Medicaid.
As of January 1, 2006, people with both Medicare and
Medicaid will no longer have their medications paid for
by Medicaid, but will instead be covered through the
new Medicare prescription drug coverage.
The Centers for Medicare & Medicaid Services (CMS),
which oversees these programs, is committed to assuring
a safe and appropriate transition for people with Medicare
and Medicaid, and SAMHSA is committed to assisting with
CMS has established certain safeguards for people with
mental illnesses and for people with Medicare and Medicaid.
For example, Medicare requires prescription drug plans
to include at least two medications within each class
of drug. However, CMS has designated six classes of drugs
"of special interest," and three of these include
medications used most frequently by people with mental
illnesses: antidepressants, antipsychotics, and anticonvulsants.
In these drug categories, plans are required to offer
virtually all available medications.
This and other safeguards are part of an overall CMS
strategy to provide comprehensive coverage, ensure continuity
of coverage, work with states, protect special populations,
and offer outreach and education to help people sort
through the various choices they will need to make. SAMHSA
will be especially active in educational efforts.
Modernizing Medicare is an enormous task, but SAMHSA
is committed to helping consumers and providers of services
as well as other stakeholders overcome any potential
challenges and make the most of this new opportunity.
Charles G. Curie, M.A., A.C.S.W.
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