Objective: Drug coverage for dual-eligible patients switched from Medicaid to Medicare Part D in January, 2006. We assessed primary care physicians' current beliefs regarding the impact of the switch on dual-eligible patients and physicians, and examined possible differences based on the restrictiveness of states' Medicaid drug coverage. Methods: In an ongoing web-based survey of 2,200 randomly-selected primary care physicians in Florida, Massachusetts, North Carolina, and Texas, respondents were asked how aspects of drug access changed under Part D relative to pre-Part D Medicaid coverage. Physicians were contacted by mail and offered a cash honorarium for participation. Chi-square tests compared responses between physicians in states with less-restrictive Medicaid drug coverage (NC) and states with more-restrictive Medicaid coverage (FL, MA, TX). Results: There were 229 survey respondents (1,942 eligible, 11.8% response rate) at the time of abstract submission. Findings are reported as percentages of respondents indicating a feature was worse/unchanged/better under Part D relative to Medicaid. Most respondents reported dual-eligible patients' access to drugs (54/22/24%) and satisfaction (61/23/16%) were worse in Part D, but patient compliance (29/61/10%) was unchanged. Most physicians also reported their ability to prescribe preferred medications (60/29/11%) and administrative burden of writing prescriptions (56/30/15%) were worse in Part D. Findings differed by the restrictiveness of states' Medicaid drug coverage. Respondents from NC were more likely to report Part D was worse than Medicaid for: dual-eligible patients' access to medications (72/20/9% vs. 43/23/35%, P<0.001), satisfaction (77/17/6% vs. 50/27/23%, P<0.001), and compliance (40/55/5% vs. 21/65/14%, P=0.008); and physicians' prescribing preferred drugs (80/20/0% vs. 47/35/18%, P<0.001) and administrative burden (80/17/2% vs. 38/38/23%, P<0.001). Conclusion: These preliminary data indicate physicians believe Medicare Part D has adversely affected dual-eligible patients previously covered under Medicaid. The transition to Part D coverage for dual-eligible patients is viewed less negatively in states with more-restrictive Medicaid coverage.