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

[Guest guest]

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.

ph 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=1137906000 & en=6

760ab57e0838a2f & ei=5094 & 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, 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. 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. 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. , director of emergency services at

Ten Broeck Hospital, a

psychiatric center in ville, 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.

ph 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. 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 ville,

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. "

D. Ranne, president of the ville

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.

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.

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

FAIR USE NOTICE

This email contains copyrighted material the use of which has not

always been specifically authorized by the copyright owner. I am

making such material available in my efforts to advance understanding

of environmental, political, human rights, economic, democracy,

scientific, and social justice issues, etc.

I believe this constitutes a 'fair use' of any such copyrighted

material as provided for in section 107 of the US Copyright Law. In

accordance with Title 17 U.S.C. Section 107, the material in this

email is distributed without profit to those who have expressed a

prior interest in receiving the included information

for research and educational purposes. For more information go to:

http://www.law.cornell.edu/uscode/17/107.shtml

If you wish to use copyrighted material from this update for purposes

of your own that go beyond 'fair use', you must obtain permission

from the copyright owner.

_______________________________________________

[Guest guest]

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.

ph 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=1137906000 & en=6

760ab57e0838a2f & ei=5094 & 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, 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. 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. 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. , director of emergency services at

Ten Broeck Hospital, a

psychiatric center in ville, 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.

ph 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. 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 ville,

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. "

D. Ranne, president of the ville

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.

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.

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

FAIR USE NOTICE

This email contains copyrighted material the use of which has not

always been specifically authorized by the copyright owner. I am

making such material available in my efforts to advance understanding

of environmental, political, human rights, economic, democracy,

scientific, and social justice issues, etc.

I believe this constitutes a 'fair use' of any such copyrighted

material as provided for in section 107 of the US Copyright Law. In

accordance with Title 17 U.S.C. Section 107, the material in this

email is distributed without profit to those who have expressed a

prior interest in receiving the included information

for research and educational purposes. For more information go to:

http://www.law.cornell.edu/uscode/17/107.shtml

If you wish to use copyrighted material from this update for purposes

of your own that go beyond 'fair use', you must obtain permission

from the copyright owner.

_______________________________________________

[Guest guest]

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.

ph 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=1137906000 & en=6

760ab57e0838a2f & ei=5094 & 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, 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. 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. 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. , director of emergency services at

Ten Broeck Hospital, a

psychiatric center in ville, 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.

ph 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. 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 ville,

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. "

D. Ranne, president of the ville

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.

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.

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

FAIR USE NOTICE

This email contains copyrighted material the use of which has not

always been specifically authorized by the copyright owner. I am

making such material available in my efforts to advance understanding

of environmental, political, human rights, economic, democracy,

scientific, and social justice issues, etc.

I believe this constitutes a 'fair use' of any such copyrighted

material as provided for in section 107 of the US Copyright Law. In

accordance with Title 17 U.S.C. Section 107, the material in this

email is distributed without profit to those who have expressed a

prior interest in receiving the included information

for research and educational purposes. For more information go to:

http://www.law.cornell.edu/uscode/17/107.shtml

If you wish to use copyrighted material from this update for purposes

of your own that go beyond 'fair use', you must obtain permission

from the copyright owner.

_______________________________________________

[Guest guest]

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.

ph 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=1137906000 & en=6

760ab57e0838a2f & ei=5094 & 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, 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. 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. 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. , director of emergency services at

Ten Broeck Hospital, a

psychiatric center in ville, 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.

ph 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. 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 ville,

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. "

D. Ranne, president of the ville

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.

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.

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

FAIR USE NOTICE

This email contains copyrighted material the use of which has not

always been specifically authorized by the copyright owner. I am

making such material available in my efforts to advance understanding

of environmental, political, human rights, economic, democracy,

scientific, and social justice issues, etc.

I believe this constitutes a 'fair use' of any such copyrighted

material as provided for in section 107 of the US Copyright Law. In

accordance with Title 17 U.S.C. Section 107, the material in this

email is distributed without profit to those who have expressed a

prior interest in receiving the included information

for research and educational purposes. For more information go to:

http://www.law.cornell.edu/uscode/17/107.shtml

If you wish to use copyrighted material from this update for purposes

of your own that go beyond 'fair use', you must obtain permission

from the copyright owner.

_______________________________________________