[Mb-civic] The States Step In As Medicare Falters - Washington Post

[William Swiggard]

The States Step In As Medicare Falters
Seniors Being Turned Away, Overcharged Under New Prescription Drug Program

By Ceci Connolly
Washington Post Staff Writer
Saturday, January 14, 2006; A01

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.


http://www.washingtonpost.com/wp-dyn/content/article/2006/01/13/AR2006011301738.html?nav=hcmodule
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