Mental Health Current Topics in Mental Health

Mental Health Lost in Medicare Haze

As officials work to fix the initial glitches in the new Medicare drug plan, Rahi Rannamaneni looks around his tightly packed pharmacy and shakes his head.

"It's only getting worse," he says.

His drug store sits in a modest New York City neighborhood, just a half block down from the Upper Manhattan Mental Health Center, where anyone can walk in off the street to get psychiatric care. Many of Rannamaneni's customers are on a fixed income and rely on government subsidies to help pay for their medications.

Still, until the start of 2006, Rannamaneni had few troubles filling their drug orders through Medicaid, the insurance of last resort. When Medicaid beneficiaries were automatically switched over to various private insurers under Medicare Part D, Rannamaneni was propelled from local pharmacist to becoming part insurance agent and part loan officer, as well.

"A lot of them still don't know what plan they have," he says, nearly a month after the new arrangements went into effect.

Rannamaneni and his staff continue to spend countless extra hours on the phone, calling anywhere from four to ten different numbers just to fill one prescription, and even when they do get through there can be bad news on the end.

"I finally reach someone and then the drugs are not covered," he says.

The shortfall ranges from simple sleeping pills to more potent anti-psychotic drugs. For the time being, Rannamaneni is helping defray much of the costs himself.

"I give them the medications and tell them we'll figure out the money later," he says.

Help on the Way?
This generosity is one of the few things keeping some unstable patients from sinking deeper into trouble. Advocates for the mentally ill say they have heard of a spike in relapses and hospitalizations after people with deep psychiatric problems could not get the drugs through their new insurance.

Michael Leavitt, the head of Health and Human Services, said there were clear glitches in the initial Medicare roll out but vowed that any problems would be fixed soon.

"We are working around the clock to make sure all seniors who participate can take full advantage of the benefit," he said last week.

But some worry that this breakdown in coverage is likely to persist for those with mental illness. Depending on where they live, psychiatric patients are often given a 90-day supply of medications, which means that plenty of former Medicaid beneficiaries have not refilled their prescription under the new plan.

"We are just seeing the first wave now," says Sam Muszynski of the American Psychiatric Association.

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