RespiteMatch.com Health Blog

ROBERT DODGE AND SUZANNE MARTA

The Dallas Morning News

Bush administration officials pledged Monday to work this week to resolve bureaucratic glitches that have left seniors empty-handed when they tried to fill prescriptions under Medicare’s new drug plan.
Health and Human Services Secretary Michael Leavitt said officials are aware of the problems and are working with governors, state health officials, health care plans and pharmacists to iron out troubles.
“We do not want anyone to leave a pharmacy counter without their prescription filled,” Leavitt said in an interview. “There are tools for pharmacists to fill their prescriptions.”
Leavitt said the vast majority of beneficiaries are not having trouble but said individual issues will keep popping up until the program is fully implemented. “Many of these are individual problems,” he said.
The rollout of the drug plan, however, has frustrated some pharmacists and patients alike.
Howard Aldridge, an Oak Cliff, Texas, pharmacist, spent Monday trying to sort out lingering Medicare-related problems for customers while his pharmacy was closed for the Martin Luther King holiday.
“I’ve been here since 10 a.m., and I still haven’t gotten through the first one,” Aldridge said Monday afternoon. “I feel like a dog chasing his tail.”
“My medicine has gone out the door, and I’ve got Medicaid and Medicare squabbling about who should pay,” he said.
For some local Medicare beneficiaries, navigating the new system has proved to be a mental and financial headache.
Ralph Green of Fairview put off filling a prescription for pain medication because his new drug benefit ID card hadn’t arrived. He opted to pay out of pocket and get reimbursed.
“Luckily, it wasn’t too expensive,” said Green, 78.
Plano resident Bob Young, 65, got his first prescriptions on Saturday with just one problem: The company charged him double the $75 co-pay he was expecting.
After being on hold with his insurer for 20 minutes on Monday, a recording told him it would be another 40 minutes to talk to someone.
“I hung up,” he said, adding that he plans to try again this week.
Even with the glitches, Young said he’s still better off.
“My wife and I will save about $2,000 each over what we paid last year,” he said.
In an effort to ease some concerns, Medicare officials are reminding health insurance plans to provide a 30-day supply of any drug beneficiaries are taking as problems are worked out.
Under the law, insurance plans already are allowed to provide a month’s supply even if their plan does not cover a specific drug. Medicare officials urged insurance plans to waive requirements that pharmacists get pre-authorization to issue drugs critical to seniors.
“We are reminding all the plans that they must follow this. This is required,” said Medicare spokesman Gary Karr.
On Friday, the government’s Centers for Medicare and Medicaid Services (CMS) sent directives to health plans urging them to follow the law and additional guidance Medicare issued this month to expedite filling prescriptions.
“We must stress that delaying or denying the filling of initial prescriptions for new enrollees at point-of-sale … is not consistent with the intent of CMS transition policy,” said a government directive.
Karr, the Medicare spokesman, said the agency chief Mark McClellan was working to pinpoint problems.
In addition to giving seniors a 30-day supply of drugs, Medicare officials also urged insurance plans to establish dedicated phone lines for pharmacists to eliminate long waits.
“We will reduce the wait times for beneficiaries and pharmacists in order to avoid any beneficiary leaving the pharmacy without prescriptions,” McClellan said in his message to health care plans.
Some problems involved the most needy beneficiaries who participate in both Medicare and Medicaid, the health program for the poor, and are called dual-eligibles.
In addition to making drugs available, Medicare officials directed health plans to charge co-payments no higher than $2 for generic drugs and $5 for brand-name drugs.
Karr said some dual-eligibles may have encountered problems because of a glitch at Medicare. He said some may have dropped off the rolls when they decided to change health plans.
He said Medicare officials have retransmitted a list of dual-eligibles to health plans so that no one is denied medications.
“We are examining our systems to make sure there is not some hole where people are not getting picked up,” Karr said.
The recent action came as tens of thousands of seniors were denied drugs or asked to pay excessive co-payments since the benefit became available on Jan. 1.
Many of the problems appear to lie with the private health insurance companies that are implementing the so-called Medicare Part D program on behalf of the federal government.
Pharmacists have complained they cannot determine whether some beneficiaries are enrolled in a plan and whether their specific drugs are covered by insurance companies. They also have complained that they often cannot get through clogged telephone lines to insurers.
It may take several days to know whether the latest efforts fix the problems.
Jim Martin, executive director of the Texas Pharmacy Association in Austin, said Monday that pharmacists’ frustrations are common among his 4,000 members.
“It’s been a fiasco,” Martin said. “Pharmacists are caught in the middle between the government and the private plans.”
In some cases, pharmacists have struggled to get accurate information from the call centers they’re advised to contact for help. And although members have reported things are gradually getting better, “it’s got a long way to go,” Martin said.
The so-called Medicare Part D program was enacted in 2003 by Congress and President Bush and is the biggest expansion of the seniors’ health care plan since it was created in 1965.
So far, Medicare has enrolled 21 million seniors and has set a goal of signing up 28 million to 30 million of its 42 million beneficiaries by this spring. The enrollment period for 2006 closes May 15.
The majority of seniors already in the plan have not experienced problems, and Medicare officials estimate they are filling 1 million prescriptions daily.