The Medicare Prescription Drug Plan Disaster

Posted on January 20, 2006

The New York Times is one of many newspapers detailing the absolute nightmare that is the new Bush-sponsored Medicare prescription drug plan. The entire plan is so complicated and full of flaws that many low-income seniors are not being able to get their prescriptions at all. Under the old law, anyone on Medicaid got their drugs free. It was as simple as that. Anyone who is poor enough to qualify for Medicaid is in really bad shape -- these are our most vulnerable citizens, many of whom are mentally ill. But under this new law, many people on Medicaid got moved into Medicare and are either a) being denied prescriptions entirely b) charged new, higher co-pays they can't afford or c) have been lost by the system entirely as their names now don't appear on any Medicare-approved lists.

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.

The entire plan was drafted by the drug companies, and is so complicated that most people can't even understand it. CNN had a piece where a former accountant who was obviously very intelligent described how he and his wife had to spend hours and hours pouring over the regulations to figure out which plan to sign up for.

But so many of the people on Medicaid are mentally impaired, including the numerous dementia and Alzheimers patients. They are simply unable to comprehend the complex decisions being required of them. Of course, that implies that if one could just understand the plan, one would see what a great deal it is. It isn't. The entire piece of legislation is a shining example of drug company greed and the amazing boldness of lobbyists such as the recently-indicted Jack Abramoff. It is our elderly, our poor and our mentally ill that are paying the price.