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Medicare Drug Plan Starts Amid Many Hassles for Consumers, Pharmacists

Posted on: Wednesday, 4 January 2006, 21:00 CST

By M. William Salganik, The Baltimore Sun

Jan. 5--Leroy Harrison, of West Baltimore, walked from the afternoon chill into Mt. Vernon Pharmacy yesterday afternoon to fill a prescription under the new Medicare drug plan.

Though he had chosen a plan -- at 45, he's eligible because he is disabled -- he didn't yet have a membership card. But, with a sheet of paper clutched in his hand, he said, "I got a letter saying the card is on its way, and if anybody has any questions, I should show them this letter."

Stephen Wienner, the pharmacist and owner, punched the information into a computer connected to the Medicare enrollment system, which instantly confirmed that Harrison was, in fact, a member, and that his plan covered his prescription for Wellbutrin, an anti-depressant.

Because Harrison, a regular customer, had been switched over from Medicaid, a program for low-income people, Wienner expected the computer to report a $3 co-pay. Instead, it came back $129.

Wienner dialed the number for the prescription plan on a speaker phone. He bustled behind the counter, filling other prescriptions while a recording periodically repeated, "All our representatives are busy." After 11 minutes, Wienner gave up and handed Harrison the prescription for $3, figuring he would resolve the billing later.

Variations of the scenario played out across the country this week as the biggest new entitlement program since Medicare began. So far more than 7 million people have enrolled in the new Medicare prescription plans or have been switched from Medicaid.

But not all 7 million have membership cards yet. Not all 7 million are in the Medicare computer. Not all 7 million are sure which plan they're in; there are 47 different prescription plans offered in Maryland.

And pharmacists report they often have long waits or can't get through at all to Medicare, to the insurers or to pharmacy benefits managers on the phone.

But, they say, patients who need medicine will get it.

Nobody's got a way to measure how many hassles there have been as the program starts up.

Paul Baldwin, executive director of the Long Term Care Pharmacy Alliance, a Washington trade group for pharmacies that serve nursing homes, said his members were reporting that about 60 percent of former Medicaid patients were being verified by the Medicare computer last week, as the pharmacies prepared for the Jan. 1 switch. Now, he said, it's over 80 percent.

"Things have begun to improve markedly," Baldwin said.

"Initially, on Monday and Tuesday, there was a fair amount of problems getting connected to the system and getting ID numbers," said Tiffani Bruce, a spokeswoman for Walgreen Co., the country's largest pharmacy chain in sales volume.

There were fewer problems late Tuesday and yesterday, Bruce said. And, if membership can't be verified, "we would never send somebody away who has an emergency need." Patients are given a limited supply of the medications, and the pharmacy will try to verify membership and fill a full prescription in a few days, she said. Based in Deerfield, Ill., Walgreen has 5,080 stores, including 107 in Maryland.

While patients are getting their medications, however, pharmacies are still worried about whether they'll ultimately get paid.

Wienner said he is "90 percent sure" that co-payments will be straightened out.

Jeff Sherr, pharmacist and owner of Apple Discount Drugs in Salisbury, was more concerned. "If they should have paid you $100, and you're selling it for $3, you can't stay in business that way," he said.

Sherr said he has been on hold with Medicare or various insurers for more than an hour at a time. Sometimes, he said, trying to verify information seems "like going down to Ocean City and trying to move sand from one end of the boardwalk to the other."

Both Sherr and Wienner said they'd added an extra pharmacist and an extra technician this week.

Among other problems: Wienner yesterday spent 5 minutes on hold and another 5 minutes talking to a representative of a pharmacy benefits manager -- "You're the first human I've spoken to at a PBM in three days," he told her. In the end, he had verified membership information for a regular customer who wanted to refill nine prescriptions -- but learned that she's in a plan that doesn't have a contract with his pharmacy. He said he would send her to another pharmacy where she could get her medicine immediately, but would help her switch to a different plan.

Some delays are unavoidable, said Lorraine Ryan, a spokeswoman for Centers for Medicare and Medicaid Services, the agency that administers Medicare. "In some cases beneficiaries who enrolled in very late December may experience minor delays as they go to the pharmacy this week -- the same delay that would happen for someone who took a new job and got insurance the day before they went to the pharmacy," Ryan said in an e-mail interview.

And the phones have been busy -- more than 120,000 calls to 1-800-MEDICARE logged in yesterday by 3 p.m., Ryan said.

Overall, Ryan said, "Reports from pharmacists and beneficiaries across the country show that people with Medicare enrolled in the new prescription drug program are receiving their drugs at their pharmacies."

Local governments monitoring the Medicare launch said it's too early to judge the degree of problems.

Arnold J. Eppel, director of the Baltimore County Department of Aging, said he received a few reports of Medicaid beneficiaries who hadn't been enrolled correctly in Medicare.

Dr. Joshua Sharfstein, the health commissioner in Baltimore City, said that by mid-afternoon yesterday his department's Medicare monitoring system had received just 11 reports of problems. The health department has set aside $50,000 for emergency purchases of medicine, but, so far, hasn't had to dip into the money, he said.

The health department has converted a conference room into a "war room," where three preventive medicine residents from University of Maryland Medical School log complaints into a database.

"In a couple of weeks," Sharfstein said, "we'll be in a position to know how things are going."

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Source: The Baltimore Sun, Maryland

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