New Medicare Drug Plan Confusion Deepens

Jan. 16, 2006 — -- It has been less than three weeks since the much-anticipated Medicare drug benefit took effect, but the new system is already sputtering, leaving thousands of people with rejected prescription claims and states scrambling to cover the costs.

Medicare recipients and pharmacists from across the country are complaining that the new system, which is supposed to be part of the cornerstone of healthcare for the nation's seniors, isn't working the way it should -- and that thousands who switched over to the new plan in the last few months are either mislabeled in the system or not in the system at all. And calling the government hotline to solve the problems hasn't brought much help.

"Their lines were busy, they would hang up on you, they had a nice recording saying 'Due to the volume we are not able to speak with you, please call later," said Virginia Mahan, an retiree in Texas who signed up for the new plan in December through the American Association for Retired Persons.

Pharmacists are singing a similar tune.

"It's been a complete nightmare," said Don Smith, a pharmacist in Little Rock, Arkansas.

Meanwhile, the Bush administration said that the system is working just fine for hundreds of thousands of people, but it is addressing the problems in a number of ways, such as increasing staffing of telephone help lines.

Government officials in charge of the new drug program say many of the problems stem from so many people signing up just before the program was launched on the first of the year. In addition, there have been problems getting the right information in the system for people who are eligible for both Medicare and Medicaid-- the so-called "dual-eligible" participants.

"We clearly need to work through this," said Michael Leavitt, Secretary of Health and Human Services. "We are hearing about these problems and are doing everything we can."

That includes increasing the number of people manning the phones by more than 400 percent and coming up with stop-gap solutions to make sure seniors don't miss their drugs. According to a New York Times report, the government also issued a directive over the weekend requiring insurers to give at least a 30-day supply of medication previously prescribed to a beneficiary. In addition, the directive also requires them to hold the cost of medications to no more than $5 for low-income beneficiaries.

"We don't want anyone to not have their drugs. We'll find a way, " Leavitt said, adding that pharmacists who honor prescriptions that are coming up 'denied' in the system will be reimbursed. "We're going to make sure they get paid."

But these efforts lag behind several states, which already recognized the problem and took action on their own. From California to Minnesota, state governments issued emergency legislation to make sure their citizens are covered. For example, California Gov. Arnold Schwarzenegger, unsure that the federal government would make the new plan workable, said his state hatched their emergency plan over Christmas and launched it Thursday.

"We expect them to pay us and reimburse us for that money," he said.

Advocates for seniors cautiously applaud the new directive, saying it's a step in the right direction that the federal government is taking the "don't-leave-the-counter-without-your-drugs" approach.

"The launch of any large program has implementation challenges (but) once the glitches have been addressed, most folks will see the value of this program," said Mark Kitchens, a spokesperson for the AARP. Kitchens added that his organization has heard some positive feedback about the program too, but that it is still "unacceptable" when even one person has trouble getting their medication.

Both government officials and advocates expect the problems to be worked out as the system gets going, but they are still concerned that some people may not get their drugs.

Pharmacists, caught in the middle, are doing their best to cope.

"We're, in a sense, funding the federal government's plan right now," said the Arkansas pharmacist Don Smith. "We don't know when we're going to get paid."

"Thank god we're not in the middle of big flu problem," said Marc Alch, a pharmacist in suburban Philadelphia.

Administration officials are urging pharmacists to call the federal government for help. But with nearly 21 million Medicare recipients who are enrolled in the new plan -- and nearly six million of them at risk for running into trouble -- the phones are often busy or offer only a long wait to speak with someone.

"We've reports of 45 minutes to four hours (by) pharmacists calling for help," said Arkansas Attorney General Mike Beebe.

Since announcing his plan for a prescription drug benefit last June, President Bush has gone to great lengths to assure Medicare recipients that there would be help for those who may be confused by the new program.

"We fully recognize that for some seniors, that this is a daunting task," he said in December after participating in a roundtable discussion on the topic. "We want to assure seniors around the country is that there is help. You can call 1-800-Medicare. You can get on the Internet with Medicare.gov. Ask your son or daughter, ask people in your church, ask people in AARP, ask people in your community center to help you look at what's available for you. It's a good deal. It's a good deal for our seniors."