Medicare Part D: Medication access and continuity problems and suicidality in psychiatric patients

Objective: Assess the relationship between medication access and continuity problems and suicidal ideation or behavior among psychiatric patients with Medicare and Medicaid insurance during the first year of the Part D benefit. Methods: Psychiatrists were randomly selected from the AMA Masterfile. After excluding those not practicing and with undeliverable addresses, 1,556 (62%) responded; 63% met study eligibility criteria and reported clinically detailed information on one systematically selected patient (N=1616). Propensity score analyses compared individuals who had experienced suicidal ideation or behavior with similar individuals who had not experienced suicidality. Results: Overall, 16% of patients had an increase in suicidal ideation or behavior during the past year. Patients with medication access problems had four times the rates of suicidal ideation or behavior compared with patients with no access problems (22% vs. 5%, P<.0001). Mean odds ratios (all p-values < .05) and excess probabilities were highest for patients who: were previously stable, but were required to switch medications (Mean OR = 4.12); could not be prescribed clinically indicated/preferred medications because of coverage or approval issues (Mean OR =3.25); could not access refills or new prescriptions because they were not covered or not approved (Mean OR =3.07); and experienced any medication access problem (Mean OR = 3.14). Conclusions: Dual eligible psychiatric patients with medication access problems had significantly higher rates of suicidal ideation or behavior. The observed link to administrative procedures suggests that sensitivity to the needs of highly vulnerable patients and changes to address those needs may ease suffering and save lives.