Map of life expectancy at birth from Global Education Project.

Friday, May 11, 2007

One More Reason Why We Need . . .

Universal, Comprehensive, Single Payer National Health Care.

New Study Shows More than Half of Medicare Part D Patients Delayed in Accessing Psychiatric Medications. (PDF) Here's part of a summary of this release. (Thanks to Aunt Deb for the tip):

A new study published in the American Journal of Psychiatry (AJP) details the often devastating consequences the transition from Medicaid to Medicare Part D drug coverage had for people with both Medicare and Medicaid (dual eligibles) receiving treatment for mental illness.

The study found that coverage restrictions imposed by Part D plans in violation of guidelines for patient protection issued by the Centers for Medicare & Medicaid Services (CMS) interrupted treatments for schizophrenia and severe depression, sending scores to the emergency room and triggering suicidal behavior.

Using a survey of 1,183 psychiatrists across the country with dual-eligible patients, the study found that, during the first four months of 2006, over half of the psychiatrists’ patients experienced at least one problem getting their medications and nearly one-third were cut off from access to required refills of medicines that had been covered under Medicaid.

The primary reason for access and continuity problems, the researchers report, is that needed medicines were not on a plan’s formulary, or list of covered drugs. Two-thirds of patients had trouble getting their prescriptions, because their plans did not cover those drugs. The drugs most subject to access barriers were antipsychotics and antidepressants, even though Part D plans were required to cover all drugs in these classes.

Researchers found that about one in five patients had been clinically stable on prescribed courses of treatment prior to the transition but were required to switch to a different medication by their Part D plan. Restrictions imposed by plans to control costs that have prevented patients from getting their medications include prior authorization requirements and “step therapy” requirements that force patients to try other medicines first. The private insurance companies offering Part D imposed these restrictions, even though they were required to lift any coverage restrictions that would interrupt treatment on patients already stabilized on these medicines.

Because of these sudden barriers, almost one-quarter of affected patients stopped taking prescribed medications.

Such restrictions put patients’ lives in danger: the report found that over a fifth of dual eligibles who had problems accessing psychiatric medicines experienced an increase in suicidal behaviors. Almost 20 percent ended up in the emergency room, and over 10 percent required hospitalization.

(Summary is from the Asclepios newsletter offered by the Medicare Rights Center, and you can sign up for it here.)

Okay, let's cut through the BS and understand why this happens. It's because the (then Republican) Congress insisted that private insurance companies administer Part D, take a cut off the top in profits, and try to maximize those profits by minimizing their costs, which they do by making deals with drug companies for certain drugs and not offering other drugs to their members. The claim is that this is a "free market" solution which by some arcane alchemy is supposed to benefit consumers, but obviously it does not.

Now suppose Congress had gone with the right system, which is to have Medicare buy drugs directly and negotiate with the drug companies on price. There would be a single, more comprehensive formulary for every Medicare beneficiary. Medicare, obviously, would follow its own rules, and make sure that nobody's treatment was interrupted. A single buyer would get a lower price for everybody, and we could easily set up an equivalent of the UK's National Institute for Clinical and Health Excellence, which would establish guidelines to make sure that every Medicare beneficiary got the most safe and effective treatments.

But no, that would cost some insurance company CEOs their $30 million a year salary and stock options. We can't have that, it's socialism.

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