Testimony Calls Senate’s Attention to Challenges with Medicare Drug Plan
People with Mental Illnesses and Care Providers Share Implementation Issues

For more information, contact Communications@nccbh.org or 301-984-6200, ext. 228

Rockville, MD-February 2, 2006—The National Council for Community Behavioral Healthcare testified today, through Michael Donato and Sharon Farr, at a hearing called by the U.S. Senate Special Committee on Aging, chaired by Senator Gordon Smith (R-OR), to examine the implementation challenges of the new Medicare drug benefit.

Michael Donato from Mansfield, Ohio has schizophrenia and bipolar disorder. Before January 1, he was not able to get all his drugs under the Medicaid program. Donato said in his testimony to the Senate, “Now, for the first time (with Medicare), I can take all nine of the medications I need. But I couldn’t have handled all this without help. What happens to the people who don’t have the help I had?” Without his medications, Donato risks hospitalization.

Donato is among the nearly 6.3 million Americans with low incomes who are dually eligible for both Medicaid and Medicare and had to start getting their prescriptions through Medicare on January 1.

Donato and many others like him experienced many challenges in accessing the new Medicare drug benefit and got help from Sharon Farr, accounts receivable supervisor, and her team of case managers at the Center for Individual and Family Services in Mansfield, Ohio. Farr also testified at the Senate hearings on Thursday. She explained that one in every five of the dual eligible persons with mental illnesses that her center serves had problems accessing their medicines throughout January. She and five other staff members spent nearly 300 extra hours last month to help dual eligibles get their medicines through Medicare. Staff even gave some persons free medicines from the center’s own supply of samples.

“The pharmacy charged Mike $700 for his medications. His Social Security disability check amounts to $694 per month for all his living expense,” explained Farr. “Mike needed help and I was calling CMS, AARP and Walgreens three times a day to work things out,” she added.

CMS automatically enrolled Donato in an AARP Prescription Drug Plan in late 2005. But when he tried to fill his prescriptions at Walgreens in early January, Donato did not appear on the computer system as a dual eligible qualifying for the subsidy he was entitled to and was asked to pay $700. Donato was alarmed and went to Farr for help. Farr spent hours on the phone to ensure that Donato could get his medicines. After three weeks of persistent effort, Donato was recognized as a dual eligible and can now afford all nine drugs that he needs.

The National Council has received reports from mental health care providers across the country about thousands like Donato, dual eligibles with mental illnesses who have experienced problems with the new Medicare drug plan. Some have not shown up as enrolled, some were auto-enrolled in plans that did not cover their medicines and some were denied subsidies due to them and asked to come up with high co-pays. In many cases, psychiatrists were required to obtain pre-authorizations to prescribe essential medicines, but no one was available to provide the pre-authorizations.

“Congress must help if the Medicare plan is to be implemented successfully,” said Linda Rosenberg, president and CEO of the National Council. “Congress must help beneficiaries who can’t afford even nominal co-pays. Congress must require Medicare prescription drug plans to include in their formularies a broad array of medicines for mental illnesses. Mental health provider organizations must receive financial assistance under the $150 million Medicare Education and Outreach Program that the House and Senate Appropriations Committee required CMS to provide.”

Farr reiterated in her testimony to the Senate that the National Council and the mental health community at large are committed to the successful implementation of the new Medicare drug plan. However, administrative and legislative help is critical to success.

Note: Contact Communications@nccbh.org 301-984-6200, ext. 228 to schedule interviews with Michael Donato, Sharon Farr and Linda Rosenberg.