RespiteMatch.com Health Blog

By Julie Appleby and Richard Wolf, USA TODAY

WASHINGTON — Stung by reports of widespread problems with Medicare’s new prescription-drug program, the nation’s top health care official said Tuesday that the government is on the case and counseled seniors: “Don’t leave the pharmacy without your drugs.”

That has happened to thousands of Medicare beneficiaries in the two weeks since Medicare’s new drug benefit went into effect, Health and Human Services Secretary Michael Leavitt acknowledged. But Leavitt said officials are ironing out the glitches. “There is no reason for you to go without your medicines … or for you to have to pay more than you owe,” he said.

The message follows widespread reports that many of the 6.2 million low-income patients who were automatically switched from state Medicaid programs into Medicare are not getting their drugs.

Leavitt and Medicare chief Mark McClellan acknowledged Tuesday that “tens of thousands” of low-income people have had trouble with the system, which is administered by private insurance plans.

Problems include patients turned away because computers don’t show they are covered, confusion when a patient’s drug isn’t covered by an insurer’s plan, and the erroneous overcharging of low-income patients who qualify for program subsidies.

About 20 states have taken emergency action to cover drug costs for low-income residents until the problems can be resolved. On Thursday, 14 Democratic governors wrote President Bush demanding reimbursement. “The unexpected cost to states will likely be in the hundreds of millions of dollars,” the governors wrote.

Despite the problems, Medicare officials said 3.6 million people have voluntarily signed up for the program in the two months since enrollment began Nov. 15. That’s nearly one-fourth of an estimated 15 million potential new members who had limited or no drug coverage before the plan began. Seniors and disabled Americans on Medicare have until May 15 to sign up without paying late fees.

On Tuesday, Leavitt and McClellan said problems with the new program are being addressed. Leavitt, who leaves tonight on a three-day trip to meet with state officials, pharmacists and patients about the drug benefit, also said the states should be reimbursed for their costs by the private insurance plans.

Sen. Chuck Grassley, R-Iowa, chairman of the Senate Finance Committee, which has oversight over the program, called the transition of drug coverage from Medicaid to Medicare “the most challenging element of the new program.”

“I am very troubled about stories of low-income beneficiaries having difficulty getting their prescriptions filled,” Grassley said, adding that hearings were possible.

Leavitt and McClellan said Medicare has: increased by 400% the number of operators on a toll-free information line set up for pharmacies; reminded pharmacists that people can be enrolled right at the pharmacy counter; directed insurers to boost their customer service and to provide at least one refill of each prescription; and encouraged beneficiaries with problems to call 1-800-MEDICARE and ask for help. They said hundreds of caseworkers are available nationwide.

“We’ve already resolved tens of thousands of cases in this particular way,” Leavitt said.

Pharmacists say much of the burden is on them to work out beneficiaries’ problems on the spot with insurance plans. “Our wait on the telephone averages from 45 minutes to two hours,” said Lynn Shipp of Senior Care Pharmacy, which serves long-term care facilities in four states.

Ray Macioci of Pilgrim Pharmacy in the Bronx said it’s unrealistic to say no one should leave the pharmacy without his or her drugs. “That … statement is ludicrous without having in place a procedure” to allow pharmacies to be reimbursed promptly, he said.

Leavitt said the problems will be worked out “one pharmacy, one beneficiary, one state at a time” until “people are getting what they need.”