Press

Drug Plan Nightmare Worsens; State may step in to assist seniors

By MEG HECKMAN
Concord Monitor
January 6, 2006

January 6, 2006; New Hampshire will provide temporary supplies of pills to some seniors who have been unable to fill their prescriptions under the new Medicare drug benefit, a federal program Gov. John Lynch yesterday deemed a "mess" and a "nightmare."
Hundreds of local seniors have run into problems since the program, known as Plan D, began Sunday. Hardest hit are those who receive services through Medicaid, which uses state, federal and county money to pay health care costs for the poor. In the past, Medicaid covered their prescription drugs as well, but now eligible seniors been shifted on to Medicare.
The switch has not been smooth: Low-income beneficiaries should be charged $1 to $3 per prescription, but some say they've had to pay $30 or more. In other cases, pharmacists are refusing to refill prescriptions because they don't have enough billing information. Social workers report that many of their clients are enrolled in the wrong type of plan, one that doesn't cover their drugs. And seniors who signed up months ago are discovering that their information is missing from the federal database.
Lynch and state health officials suspected the launch would mean trouble for low-income seniors and drew up a contingency plan last month, said Lynch spokeswoman Pam Walsh. If a Medicaid recipient doesn't have the necessary Plan D information, pharmacists should fill the prescription and bill the state, she said.
"Governor Lynch certainly shares the frustration of New Hampshire citizens on the federal mess," Walsh said. "Anticipating the nightmare, New Hampshire took a number of steps."
Health officials are tracking complaints and trying to pinpoint where the system is breaking down. Once the problems are sorted out, the state will seek repayment from the insurance companies sponsoring plans.
"The pharmacists will get paid,"said Health and Human Services spokesman Greg Moore. "We'll have to chase the money."
Federal officials, meanwhile, say the program is working for the majority of beneficiaries. Larry Kocot, senior policy adviser for the Centers for Medicare and Medicaid, said yesterday that the rollout was going well despite network delays and confusion among pharmacists. Kocot said Medicare offices have received complaints, and most problems will be fixed in the coming days.
"While we've made significant progress this week, there's much work to be done," he said. "It's not the fault of the pharmacies, it's not the fault of CMS, it's not the fault of the patient. We're just asking people to give us time."
When a reporter asked Kocot what seniors should do if they can't obtain their drugs, he said he "doubted the premise of the question." Roseanne Pawelec, Medicare's New England spokeswoman, said anyone unable to fill their prescriptions should call 1-800-MEDICARE.
"There are instances of this occurring in every New England state," she said. "But the trouble-shooting that is going on is resolving a number of these issues as fast as possible."
But social workers and seniors say the hotline - and similar services offered by insurance companies - have long waits and that, often, the operators don't have answers. Sherri Collins, of Manchester, says she just doesn't have the time to make another call, although she'll soon have to pay cash for her mother's asthma medication.
"In between changing my mom's sheets three times a day, and giving her a shower and crushing her meds to put them in the feeding tube, I call the pharmacy and they say, 'No, you can't get the drugs you need to stay alive,'" said Collins, whose mother has Parkinson's disease. "I don't have the time to be on the phone begging for her medicine. I need that time to take care of her."
Collin's mother signed up for a plan last month, but her membership card has yet to arrive. Without it, the pharmacy will charge full price for each drug. Medicaid recipients knew that after the switch they would have to make co-payments on their drugs, but most expected to pay $1 to $3 per refill. Instead, seniors have been charged $30 or more for insulin, cardiovascular drugs or anti-psychotics.
"There's a lot of inconsistency in what's being covered and what the co-pay is," said Ellen Curelop, president of Life Coping Case Management in Nashua. "Last week, these clients who were on Medicaid went in . . . to a pharmacy and came out with their medications without paying for them. This week, that's not the case. That's a big change for people who are financially disadvantaged."
Mike Ventola, a case manager and nurse at Heritage Case Management in Concord, has had a particularly hard time with clients enrolled in the AARP United Plan. A spokesman for AARP said last night that the problem, which is cropping up across the country, is the result of a glitch in the federal Medicare system.
Ventola helped 20 seniors sign up for the plan last month; none have been able to fill their prescriptions this week because they have yet to receive their identification numbers. Five of them aren't in the federal database at all.
"A lot of people picked AARP . . . because at least it was a familiar name, thinking it would be the easiest transition for them," he said. "That's not the case. . . . You're at the mercy of the phone lines, and people are and will be going without drugs."