A Prescription for Disaster--Shift to Medicare leaves Patients Stranded_NYT

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[sSRI-Research] A Prescription for Disaster--Shift to

Medicare leaves Patients Stranded_NYT

 

 

 

 

ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)

Promoting Openness, Full Disclosure, and Accountability

www.ahrp.org

 

FYI

 

In what appears to be a re-run of the Katrina rescue disaster--The

New York Times front page report provides yet another example of

mindless and heartless shot gun public polices that are being tested

on a vulnerable population of citizens:

 

" Medicare's free-standing prescription drug plans are not responsible

for the costs of hospital care or doctors' services. " They have no

business incentive to worry about those costs, " said Dr. Joseph J.

Parks, medical director of the Missouri Department of Mental

Health, who reported that many of his Medicare patients had been

unable to get medicines or had experienced delays. "

 

Unlike the incompetent former head of FIMA, Dr. Mark McClellan,

former FDA commissioner, currently chief of Medicare, and the

disastrous prescription drug plan that is wreaking havoc with the

health of the elderly and the disabled, holds a medical degree from

Harvard and a PhD in economics from MIT.

 

Just like in the aftermath of Katrina we are told: " Federal

officials said they were moving aggressively to fix problems with the

drug benefit. About 250 federal employees have been enlisted as

caseworkers to help individual patients. The government has told

insurers to provide a temporary supply - typically 30 days - of any

prescription that a person was previously taking. And Medicare has

sent data files to insurers, supposedly listing all low-income people

entitled to extra help with premiums and co-payments. "

 

" Sponsors of the 2003 Medicare law wanted to drive down costs by

creating a competitive market for drug insurance. They focused on

older Americans, not the disabled. They assumed that beneficiaries

would sort through various drug plans to find the one that best met

their needs. But that assumption appears unrealistic for people at

Dayspring Village. "

 

 

Contact: Vera Hassner Sharav

veracare

 

http://www.nytimes.com/2006/01/21/politics/21drug.html?

hp & ex=37906000 & en=g60ab57e0838a2f & ei=P94 & partner==homepage

 

January 21, 2006

 

Medicare Woes Take High Toll on Mentally Ill

By ROBERT PEAR

 

HILLIARD, Fla., Jan. 16 - On the seventh day of the new Medicare drug

benefit, Stephen Starnes began hearing voices again, ominous voices,

and he started to beg for the medications he had been taking for 10

years. But his pharmacy could not get approval from his Medicare drug

plan, so Mr. Starnes was admitted to a hospital here for treatment of

paranoid schizophrenia.

 

Mr. Starnes, 49, lives in Dayspring Village, a former motel that is

licensed by the State of Florida as an assisted living center for

people with mental illness. When he gets his medications, he is

stable. " Without them, " he said, " I get aggravated at myself, I have

terrible pain in my gut, I feel as if I am freezing one moment and

burning up the next moment. I go haywire, and I want to hurt myself. "

 

Mix-ups in the first weeks of the Medicare drug benefit have vexed

many beneficiaries and pharmacists. Dr. Steven S. Sharfstein,

president of the American Psychiatric Association, said the

transition from Medicaid to Medicare had had a particularly severe

impact on low-income patients with serious, persistent mental

illnesses. " Relapse, rehospitalization and disruption of essential

treatment are some of the consequences, " Dr. Sharfstein said.

 

Dr. Jacqueline M. Feldman, a professor of psychiatry at the

University of Alabama at Birmingham, said that two of her patients

with schizophrenia had gone to a hospital emergency room because they

could not get their medications. Dr. Feldman, who is also the

director of a community mental health center, said " relapse is

becoming more frequent " among her low-income Medicare patients.

Emma L. Hayes, director of emergency services at Ten Broeck Hospital,

a psychiatric center in Jacksonville, said, " We have seen some

increase in admissions, and anticipate a lot more, " as people wrestle

with the new drug benefit.

 

Medicare's free-standing prescription drug plans are not responsible

for the costs of hospital care or doctors' services. " They have no

business incentive to worry about those costs, " said Dr. Joseph J.

Parks, medical director of the Missouri Department of Mental Health,

who reported that many of his Medicare patients had been unable to

get medicines or had experienced delays. At least 24 states have

taken emergency action to pay for prescription drugs if people cannot

obtain them by using the new Medicare drug benefit. Florida is not

among those states.

 

In an interview, Alan M. Levine, secretary of the Florida Agency for

Health Care Administration, said: " We've set up a phone line and an e-

mail address for pharmacists. We try to solve these problems on a

case-by-case basis. We have stepped in to get drug plans to pay for

prescriptions, so people don't leave the pharmacy without their

medications. "

 

Federal officials said they were moving aggressively to fix problems

with the drug benefit. About 250 federal employees have been enlisted

as caseworkers to help individual patients. The government has told

insurers to provide a temporary supply - typically 30 days - of any

prescription that a person was previously taking. And Medicare has

sent data files to insurers, supposedly listing all low-income people

entitled to extra help with premiums and co-payments.

 

But in many cases, pharmacists say, they still cannot get the

information needed to submit claims, to verify eligibility or to

calculate the correct co-payments for low-income people. And often,

they say, they must wait for hours when they try to reach insurers by

telephone.

 

S. Kimberly Belshé, secretary of the California Health and Human

Services Agency, said the actions taken by the federal

government " have not been sufficient to address the problems that

California residents continue to experience. "

 

At Dayspring Village, in the northeast corner of Florida near

Jacksonville, the 80 residents depend heavily on medications. They

line up for their medicines three times a day. Members of the staff,

standing at a counter, dispense the pills through a window that looks

like the ticket booth at a movie theater.

 

Most of the residents are on Medicare, because they have

disabilities, and Medicaid, because they have low incomes. Before

Jan. 1, the state's Medicaid program covered their drugs at no

charge. Since then, the residents have been covered by a private

insurance company under contract to Medicare.

 

For the first time, residents of Dayspring Village found this month

that they were being charged co-payments for their drugs, typically

$3 for each prescription. The residents take an average of eight or

nine drugs, so the co-payments can take a large share of their cash

allowance, which is $54 a month.

 

Even after the insurer agreed to relax " prior authorization "

requirements for a month, it was charging high co-payments for some

drugs - $52 apiece for Abilify, an anti-psychotic medicine, and

Depakote, a mood stabilizer used in treating bipolar disorder.

 

The patients take antipsychotic drugs for schizophrenia; more drugs

to treat side effects of those drugs, like tremors and insomnia; and

still other drugs to treat chronic conditions like diabetes and high

blood pressure.

 

" If I didn't have any of those medications, I would probably be

institutionalized for the rest of my life, " said Deborah Ann Katz, a

36-year-old Medicare beneficiary at Dayspring. " I'd be hallucinating,

hearing voices. "

 

Michael D. Ranne, president of the Jacksonville chapter of the

National Alliance on Mental Illness, said the use of powerful

psychiatric medications " virtually emptied out state mental

hospitals " in the 1970's and early 80's. Ms. Katz said she had

been " in and out of hospitals " since she was 13.

 

Sponsors of the 2003 Medicare law wanted to drive down costs by

creating a competitive market for drug insurance. They focused on

older Americans, not the disabled. They assumed that beneficiaries

would sort through various drug plans to find the one that best met

their needs. But that assumption appears unrealistic for people at

Dayspring Village.

 

Heidi L. Fretheim, a case manager for Dayspring residents, said: " If

I take them shopping at Wal-Mart, the experience is overwhelming for

them. They get nervous. They think the clerks are plotting against

them, or out to hurt them. "

 

Residents of Dayspring Village see worms in their food. Some neglect

personal hygiene because they hear voices in the shower. When nurses

draw blood, some patients want the laboratory to return it so the

blood can be put back in their veins.

 

Under the 2003 Medicare law, low-income people entitled to both

Medicare and Medicaid are exempted from all co-payments if they live

in a nursing home. But the exemption does not apply to people in

assisted living centers like Dayspring Village.

 

Douglas D. Adkins, executive director of Dayspring Village,

said: " Some of the pharmacists have been saying, 'No pills unless we

get a co-payment.' Well, how are these people going to get the money

for a co-payment? They don't have it. "

 

Eunice Medina, a policy analyst at the Florida Department of Elder

Affairs, said the state was trying to " find a solution " for people in

assisted living centers.

 

" We are all aware that the next couple of months will be difficult

for these clients, and that the possibility of a transition to a

nursing home is their only option if prescriptions are not covered in

assisted living facilities, " Ms. Medina said in a memorandum to local

social service agencies.

 

Luis E. Collazo, administrator of Palm Breeze, an assisted living

center for the mentally ill in Hialeah, Fla., said many of his

residents were forgoing their medications on account of the new co-

payments.

 

" Because of their mental illness, " Mr. Collazo said, " they don't have

the insight to realize the consequences of not taking their

medications. Without their medicines, they will definitely go into

the hospital. "

 

* Copyright 2006The New York Times Company