Tuesday, February 07, 2006

Medicare Drug Plan in Action

As you may have heard the Bush administration Medicare prescription plan has not been introduced very well. It's a mess, to be honest, and one group of very vulnerable patients are the mentally ill:

Since the prescription program made its debut Jan. 1, some of the estimated 2 million mentally ill Americans covered because they receive both Medicare and Medicaid have gone without the drugs that keep their delusions, paranoia, anxieties or stress in check. Mental health service providers and advocacy organizations nationwide say they worry that scores are at high risk of relapse. Numerous people have been hospitalized.

"The continuation of medications is absolutely critical to keep them in community living," said Steven S. Sharfstein, chief executive of the Shepherd-Pratt Health System in Baltimore and president of the American Psychiatric Association. Last week, the association joined other mental health groups in a lengthy talk with Medicare officials about the myriad problems.


The mentally ill are nearly a third of the "dual eligibles" who qualify for both Medicare and Medicaid because of income and disability or age. Mark B. McClellan, head of the Centers for Medicare and Medicaid Services, told a Senate committee hearing Thursday that a prime focus is resolving the "remaining transition issues" for this extremely vulnerable population.

That will not happen quickly. Like other Medicare-Medicaid recipients, the mentally ill were to have been signed up automatically for Part D at the start of the year, with responsibility for their prescriptions shifted seamlessly to private drug plans. Clinicians expected a bumpy beginning even in the best of circumstances. The new coverage often forces beneficiaries to switch from their usual pharmacies to different locations and strange faces, changes that Pam Cudahy of St. Luke's House in Bethesda said can have a huge effect on someone with few coping resources.

"Is the environment familiar? Is the person [behind the counter] familiar? When I show my prescription card, will the same thing happen as happened before?" Such questions represent daunting challenges, explained Cudahy, whose agency provides crisis care and psychiatric rehabilitation to about 1,000 teenagers and adults. "You don't want something to happen they're not expecting."

But repeatedly, she and others say, people have fallen through the program's cracks and discovered they have no insurance -- and have either run out of pills or rationed their medicine because they feared they would be left without.

Or they have been assigned to plans that will pay for some but not all of their psychiatric prescriptions -- an untenable and potentially dangerous situation given the complicated multiplicity of drugs people often take, with some pills to treat symptoms and others to counteract side effects. Unlike many medicines, psychiatric drugs are not easily substituted.

Indeed. Many of these patients are on multiple medications for very good reasons. If some medications are disallowed, what will happen? If you cut out two of four table legs, will the table still stand?

Some mentally ill patients can live alone and work only because of their medications. Some might even be harmful to those around them without proper medications, and many might be harmful to themselves. Surely taking care of these patients should be of utmost importance to the compassionate conservatives?