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The States Step In As Medicare Falters
Seniors Being Turned Away, Overcharged Under New Prescription
Drug Program
By Ceci Connolly
Washington Post Staff Writer
01/14/06 "Washington
Post" -- -- Two weeks into the new
Medicare prescription drug program, many of the nation's sickest
and poorest elderly and disabled people are being turned away or
overcharged at pharmacies, prompting more than a dozen states to
declare health emergencies and pay for their life-saving
medicines.
Computer glitches, overloaded telephone lines and poorly trained
pharmacists are being blamed for mix-ups that have resulted in
the worst of unintended consequences: As many as 6.4 million
low-income seniors, who until Dec. 31 received their medications
free, suddenly find themselves navigating an insurance maze of
large deductibles, co-payments and outright denial of coverage.
Yesterday, Ohio and Wisconsin announced that they will cover the
drug costs of low-income seniors who would otherwise go without,
joining every state in New England as well as California,
Illinois, Pennsylvania, Arkansas, New Jersey, North Dakota,
South Dakota and New Jersey.
"This new prescription drug plan was supposed to be a voluntary
program to help people who didn't have coverage," said Jeanne
Finberg, a lawyer for the National Senior Citizens Law Center.
"All this is doing is harming the people who had coverage --
America's most vulnerable citizens."
Hailed as President Bush's signature domestic achievement, the
program, which began Jan. 1, offers drug coverage for the first
time to 43 million elderly and disabled Americans eligible for
Medicare. At the same time, 6.4 million low-income beneficiaries
who were receiving their medications through state Medicaid
plans were switched into Medicare for their drug benefits and
told they would not be charged the standard $250 deductible or
co-payments.
But interviews with two dozen people -- state officials,
pharmacists, advocates for seniors, and Medicare clients --
revealed a host of problems. Many poor seniors were never
enrolled or were enrolled in plans that do not cover their
medications. Others received multiple insurance cards, creating
confusion at the pharmacies. Some were charged the deductible
and unaffordable co-payments. And some, such as Laurine League,
left empty-handed.
"For years I've had no problems, going to the same pharmacy,"
said League, 49, a Queens, N.Y., woman with severe mental
illness. "The pharmacist told me one drug was going to cost
$198. I don't have that kind of money."
The states that have stepped in to help have already incurred
several million dollars in unexpected drug bills, but Mark B.
McClellan, administrator of the federal Centers for Medicare and
Medicaid Services (CMS), said he did not have the authority to
reimburse them. He urged states, pharmacists and providers to
work with his agency to collect reimbursements from insurance
companies administering the prescription program.
Acknowledging that some of the 6.4 million low-income
beneficiaries known as "dual-eligibles" have been overcharged or
denied medication, McClellan said: "That is simply not
acceptable. We have been working around the clock and around the
country to make sure those beneficiaries get the prescriptions
they need."
California Gov. Arnold Schwarzenegger (R), announcing his
intention to spend as much as $70 million to provide two weeks'
worth of medicine, said he expects a reimbursement. "While I am
confident the federal government will resolve the problems with
this transition, these people need our help now," he said, "and
we're going to be there for them."
Politicians in both parties were quick to rise to the defense of
a particularly vulnerable population. As a group, dual-eligibles
have incomes below the poverty rate of $9,570 a year and take an
average of 15 medications a day. More than half are women, 40
percent have cognitive impairments such as Alzheimer's and 20
percent do not speak English, according to Finberg.
"The dual-eligibles should have been the last group enrolled
because they are the hardest to get going," said Thanh Lu, who
focuses on Medicare issues at the Progress Center for
Independent Living in Illinois. Clients who are in nursing
homes, who have schizophrenia, or who are deaf or blind are ill
equipped to tackle the complex new system. Medicare compounded
the problem by sending out a handbook that incorrectly told
low-income seniors they could enroll in any plan at virtually no
cost, he said.
The first state to act was Maine, after its hotline recorded
18,000 calls on Jan. 3, said Jude Walsh, a special assistant to
the governor.
"We had dialysis patients who were not getting medicines,
pharmacies on hold for 60-plus minutes, some plans closed for
the holiday," she said, describing some of the frantic calls.
"One man called me -- he and his wife were on 15 medications.
They had no co-payments on Medicaid. He went in for 15, and he
left with one" medicine because of the cost, she said.
Yesterday the hotline uncovered a new problem, she said. Some
beneficiaries have received letters from private health plans
warning that the monthly premiums for their drug coverage will
be deducted from their Social Security checks, even though they
are poor enough to qualify for free coverage. So far, Maine has
paid for 68,000 prescriptions at a cost of $3.6 million, Walsh
said.
Some supporters of the Medicare expansion blamed pharmacists for
not learning the new system. But many pharmacists said they
attended classes and purchased new computer software in
anticipation of the Jan. 1 launch.
"The first week was pure hell," said Mike Souders, owner of
Metropolis Drugs in southern Illinois. Computer systems crashed,
phone lines were jammed, and there was no way for him to confirm
that patients were covered. He called in extra employees who
worked the phones late at night, and he asked doctors to provide
regular customers with drug samples until the confusion could be
resolved.
"In 2000, for Y2K, we were practicing running systems for a
year," he said, referring to computer preparations for the
coming of the new millennium. "They started this up cold
turkey."
Social workers and advocates have warned for months that moving
the most vulnerable patients to a new program would require a
slower, phased-in approach.
"All of the worst predictions came true," said Robert M. Hayes,
president of the Medicare Rights Center. Many of the thousands
of callers contacting the center said they were being told that
the insurance plan they were assigned by the federal government
does not cover their medications, he said.
If that occurs, pharmacists have been instructed to provide a
one-month "transitional" supply until a doctor can prescribe a
similar drug that is covered by the plan, McClellan said. In
addition, CMS has devised a 14-step enrollment process for
pharmacists, he said.
Baltimore Health Commissioner Joshua M. Sharfstein and his staff
have personally been assisting pharmacies with that effort. "I
don't think we have yet successfully counseled a pharmacist
through that," he said.
"We've been doing enrollments and they have not taken less than
an hour and a half" each, said MaryAnn Griffin, director of
Alexandria's Office of Aging and Adult Services. She recently
joined a CMS teleconference briefing but found that it was a
"listen-only, completely scripted" event that did not address
the myriad problems her staff is confronting.
From the outset, administration officials have said they would
rely on states, doctors, family members and volunteers to help
seniors negotiate the new system. But Anne Marie Murphy,
Illinois's Medicaid director, said the CMS should be resolving
the current problems.
"It's a little ironic that Congress and the administration are
talking about cutting Medicaid administrative costs, and here we
are rolling up our sleeves and doing all we can to make sure a
federal program is working," she said.
© 2006 The Washington Post Company
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