Mentally ill lose out

Disabled suffer irreparable harm after losing access to vital medications under new privatized prescription drug plan

I work in the field of mental health, and have managed or worked at group homes for people with psychiatric disabilities for several years. Most of my clients are able to live stable lives, outside of mental hospitals and in the community, largely due to the development of many new anti-psychotic medications that manage the symptoms of mental illness (i.e. hearing voices or hallucinations).

It can take years of working with a client just to get them to be willing to try taking medications. Now, because of the new prescription drug policies, many people are at risk of their lives destabilizing due to lack of medications.





Medicaid formerly paid for drugs

Up until Dec. 31, 2005, Medicaid paid for medications for poor people with mental health issues. Co-pays were low — typically between $1 and $3 per prescription — and there were no premiums or other charges.

All of that has changed. Effective Jan. 1, 2006, the Medicare prescription drug benefit — a new program touted by the Bush administration and its allies in Congress as “helpful” to the elderly and disabled — took over payment for medications for all elderly and disabled individuals who were enrolled in Medicare. Medicare recipients had until Dec. 31 to select and enroll in a privately managed prescription drug plan. If they didn’t sign up in a plan, one was selected for them.

In Massachusetts, default prescription drug plans were selected largely at random. Many plans cover as few as 70 out of the 100 most-prescribed medications. This is forcing doctors to prescribe alternative, covered medications that may be less effective for some patients.





Many plans charge premiums

Adding insult to injury, many of the private Medicare plans charge monthly premiums. People with mental illness tend to rely on tiny Social Security benefit checks to survive. Even a $20 or $30 monthly cost puts a huge dent in their income. Social workers, case managers and clinicians have had to scramble during the past few weeks to enroll their clients in plans that would cover their medications without premiums.

One of my clients, who I shall call Rick, was enrolled in Aetna Medicare, which charges a premium of $19.04 per month but only covers 86 out of the 100 most-prescribed medications. Rick informed me that he couldn’t pay this amount. Like many people with severe psychiatric illness, he smokes heavily and isn’t willing to quit. He stated that he would rather stop taking his medications and keep smoking than to fork over the monthly premium. Presently his clinician is trying to switch Rick over to another plan.





No regulation of profits

Many of the companies that manage Medicare drug benefits operate on a for-profit basis, but there is little regulation of these corporations. They have plenty of incentives to cut costs at the peril of poor people with mental illness. At any time, they can choose to change which medications they cover. This places benefit recipients at risk for relapse in their psychiatric or medical symptoms.

The obvious solution to this problem is for the United States government to adopt a National Health Service, as other advanced industrial countries have done. It is imperative that activists continue the struggle so that adequate health care is made accessible to all.



Bruce Burleson is a mental health care worker in Boston.