From the Administrator: Maximizing the Benefit of Medicare

There 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 Medicare—including 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 this.

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.
Administrator, SAMHSA

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