Glitches hitting poor hardest


Published: Friday, January 27, 2006 at 6:01 a.m.
Last Modified: Thursday, January 26, 2006 at 9:20 p.m.
Three weeks into its start-up, the new Medicare prescription drug program is plagued with headaches, and many consumers who have gone to the pharmacy for their first refill under Part D have suffered severe sticker shock.
Government officials acknowledge that "tens of thousands" of Medicare beneficiaries have had difficulty buying prescriptions under the new drug program, but say the federal government and private insurers are working to correct the situation as quickly as possible.
Medicare Part D is meant to reduce the out-of-pocket cost of prescription medications. For those who can least afford it, it doesn't seem to be working - yet.
The group hardest hit under the new rules are the so-called "dual-eligibles" - low-income residents (including some 400,000 Floridians) with chronic diseases, mental illness or disabilities who until Jan. 1 had their prescription drugs covered by the state/federal Medicaid program.
Gov. Jeb Bush said Thursday that he'll sign an executive order to immediately begin paying for drugs for as many as 100,000 Florida residents who were not able to show they had coverage under the federal Medicare program. Many have turned up at drug stores only to be told their names weren't in the system.
That's not how it is supposed to work. Dual-eligible residents were randomly assigned to a Medicare-subsidized private drug plan. They were notified by letter from the Center for Medicare & Medicaid Services, or CMS, and advised to take that letter with them to their pharmacist to verify enrollment.
Medicare officials concede that many dual-eligible consumers, who under the new drug law are not supposed to pay more than $5 for each prescription, are being asked to pay considerably more because of miscommunication between the drug plans and pharmacists. Some have been asked to pay a $250 deductible before a prescription could be filled.
No one knows how many have left the drug store without the medications upon which they depend.
Gov. Bush said as many as 100,000 Floridians may have run into problems, and they will now have help paying for their drugs through Feb. 15, when he expects the start-up problems to be fixed.
Dr. Mark McClellan, CMS administrator, said his agency is "working around the clock" to resolve these issues and CMS has expanded the number of operators on its toll-free information lines from 150 to 4,000. Insurers have been told they must provide a 30-day emergency supply of any drug that a Medicaid beneficiary was previously taking during this transition period.
Twenty states already have taken emergency action to cover the cost of drugs for low-income patients who are falling through the cracks. Federal officials agreed this week to reimburse states that bought medicine for senior citizens and disabled residents who had not been able to get help.
Secretary Alan Levine, who heads Florida's Agency for Health Care Administration, said his office is addressing system-wide shortcomings by speaking with pharmacists across the state. AHCA administers Medicaid in Florida; the agency has established an e-mail address and telephone line for all pharmacists to communicate issues that arise during the switch to the Medicare drug program.
Under the new plan, low-income older and disabled Medicare beneficiaries should be paying no more than $5 per prescription. However, nationally, tens of thousands of people have been unable to get needed drugs because they could not afford the higher co-pays or deductibles that they were mistakenly charged when they went to the drug store.
If residents previously had prescriptions filled at no cost through Medicaid - a joint state and federal health program for the poor - they shouldn't be charged substantial co-payments on drugs now. Depending on their Medicare plan, they can expect to pay $5 or less. But in many cases, the dual-eligibles are not turning up in the Medicare database and they have been billed for hefty co-payments.
Thus, when a pharmacist couldn't confirm Medicare coverage because of a computer glitch, some low-income residents have been asked to pay a $250 deductible plus a co-payment of 25 percent of the cost of each prescription.
Levine said it's more important to fix the larger glitches with the program than to try to pay for something Medicare enrollees will eventually have to cover themselves.
"Some people are complaining because they're having to pay a co-pay. Well, that was intended," Levine said. "That was the policy decision Congress made. That is not a temporary problem; that's the program."
Health and Human Services Secretary Leavitt says that problems are likely to continue until all beneficiaries in a drug plan have made at least one purchase.
"Some people are having problems getting their medicines and we're working with our partners to fix those problems," Leavitt said. "This is a new program. Some people may experience a problem the first time they go to get their medicines, but we're confident that, after you use it once, things are going to go more smoothly."
Diane Chun can be reached at 374-5041 or chund@gvillesun.com.

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