Medicare Muddle

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Stability of Mentally Ill Shaken By Medicare Drug Plan Problems

Even among the incident reports crossing Craig Knoll's desk weekly now, this one stood out: A 43-year-old client of Knoll's mental health agency, a man who suffers from bipolar disorder, had come from his pharmacy frustrated to the point of meltdown. There were snags in his new Medicare drug plan. Of his four medicines, it would fill only two.

"I'm not going to take any of them anymore," he yelled, according to the report by caseworkers. Before they could do anything, he grabbed the prescription bottles he'd just gotten, ran for the restroom and dumped both in the toilet.

For some patients, skipping a day's medication can result in severe side effects or relapse.

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.

In Alexandria last month, a mother of two with a history of homelessness and attempted suicide left a drugstore empty-handed after being told her antidepressant was not covered. "For her, it was overwhelming," said Lix Wixson, director of acute care at the local Community Services Board. "She shut down."

What this Administration is doing to this country is criminal and inhuman. And we let them do it.

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