Response from Irvin “Sam” Muszynski, J.D., director of APA's Office of Healthcare Systems and Financing:

Dr. Rahn's letter raises issues that APA's Office of Healthcare Systems and Financing (OHSF) deals with on a daily basis, primarily through calls that come to us through the Managed Care Help Line.

Since the inception of Medicare Part D, OHSF has been involved in trying to mitigate the problems that we felt certain would arise for physicians with the new program. We have developed working relationships with policy staff at the Centers for Medicare and Medicaid Services (CMS) and have worked closely with other physician groups and patient-advocacy groups since the inception of the new drug program to try to make it more workable. Even though we were able to ensure that all drug plans would be obligated to cover all or substantially all antidepressants, antipsychotics, and anticonvulsants (rather than the two choices required for most other classes of drugs), we know there are still many problems, and we continue to work with CMS to find solutions.

While we have been very successful in getting problems solved on a case-by-case basis, it has been much more difficult to effect overall policy changes since so much of Part D is bound by federal regulations. We ask APA members to please communicate their Part D problems to us; these problems give us the evidence we need to support change.

As for private managed care, through the relationships we've established with the administrators of managed care organizations, OHSF has often been able to solve the problems that APA members encounter. We hope that Dr. Rahn and all other APA members who have problems with Medicare or managed care will call the Managed Care Help Line at (800) 343-4671 or e-mail us at [email protected]. We need to hear from psychiatrists working in the field. Unless we know what the problems are, we can't find ways to solve them.