Pharmacists Give Away Meds Amid Medicare Confusion
Jan. 12, 2006 — -- Unable to determine whether their patients are on the new Medicare drug plan, many U.S. pharmacists say they now give away drugs to some seniors on blind faith, simply hoping they will be reimbursed at a later date.
But not all pharmacists can give drugs away, and those who do can't do it for long, officials say. As a result, some seniors may be denied necessary prescription drugs.
The problem centers on seniors who were automatically enrolled in the new Medicare drug plan on Jan. 1. These seven and a half million seniors, one quarter of whom are in nursing homes, are called dual eligible, because they qualify for two types of aid: Medicare and Medicaid. Because of their age and illnesses, they are the poorest, sickest and most expensive to treat health care consumers in the United States.
Many dual-eligible seniors have not confirmed which health plan covers their drugs, or they come in with problems their current health plan does not cover, pharmacists say.
"We're working around the clock and around the country to make sure everyone can get the prescriptions they need," says Centers for Medicare and Medicaid Services administrator Mark McClellan, according to a Reuters report.
Because of their delicate health conditions, dual-eligible seniors cannot necessarily just change from one drug to another. So, instead of giving seniors the drug preferred by their new health plan, pharmacists say they give some of these seniors the drug they have been taking, and hope that the health plan will still pay them.
Also, when seniors don't know which health plan they are on, some pharmacists say they will often just fill the prescription, take the patient's information, and hope that they will eventually be paid once they figure out which health plan to bill.
Ronald Baker, a pharmacist in Iowa, says roughly 50 percent of his dual-eligible patients could not get their medications if he wasn't stepping up and filling those prescriptions on good faith. But he's not sure how long he can keep it up.
"Most corner store pharmacies can't do that," Baker says. "We cannot check if a drug is covered and we cannot verify if a patient is covered and we don't know if we will be repaid. We feel like we've mortgaged our grandchildren's paychecks to pay for prescriptions."
Some seniors don't have pharmacists who can afford to do that. Jeanne Finberg, of the National Senior Citizens Law Center, says, "They're worried that they won't get reimbursed, and so many, many pharmacists are giving one- and two- and three-day supplies, or no drugs at all."
Other seniors are being told that "they must pay the full cost of the prescription, and these people can't afford it," Fineberg says. "We have people that need psychiatric drugs, anticancer drugs, anticonvulsants, convulsants, many things that will save their lives, and they're walking home without them."
Pharmacists are also giving away medicine when they believe the health plan has forced seniors to buy medicine that is less effective.
Chad Worz, an Ohio pharmacist who sees many dual eligibles, says this has happened often with the antidepressant Zoloft.
"I won't not give my patient Zoloft just because the insurance company would rather use another drug -- it's just not safe," he says.
Ethically, Worz says he cannot do exactly what the insurance company wants him to do. So Worz, like many pharmacists, fills the prescription and hopes the billing will straighten itself out. At his pharmacy, he says one-third of claims -- about $200,000 -- are currently up in the air.
"There have been e-mails from CMS [Center for Medicare Services] and conference calls," he says. "But we have to hope the insurance companies come through."
It is not just pharmacists who believe the current Medicare drug plan is experiencing serious problems. At least seven states have taken emergency action to ensure patients have access to the medications they need.
"I think 'crisis' is the word when you're dealing with a vulnerable population," says Arkansas Attorney General Mike Beebe. "If something doesn't change, more and more pharmacists who are currently ... filling this gap right now will be unable to continue to provide the medicines."
On the other hand, some pharmacists say a gradual improvement in how the Medicare drug plan works is likely.
Pharmacist Craig Bell, of San Antonio, says it is getting easier every day.
"It is much, much, much better now ... I am sleeping at night."
ABC News correspondent Erin Hayes contributed to this report.
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