Thousands of Seniors Report Drug-Plan Problems
Posted on: Wednesday, 11 January 2006, 18:00 CST
By MARSHA SHULER
Thousands of seniors report drug-plan problems
Thousands of poor Louisiana senior citizens are having trouble getting their medication through a new federal Medicare program.
State health officials reported Tuesday that they are getting inundated with calls from seniors who have not received prescription drug cards or letters from the prescription drug plans to which they have been assigned.
Among the most affected are 93,400 Louisiana seniors who traditionally received drugs through another health benefit, the state-administered Medicaid program for the poor.
As of Jan. 1, all seniors the poor and not-so-poor get their pharmacy benefits through the new federally administered Medicare Part D program for the elderly.
The program adds prescription drugs to federal Medicare health insurance, which formerly covered services such as doctor visits and hospital stays but not increasingly costly prescriptions.
The poor and elderly had been receiving prescription drugs through the Medicaid program. The transfer to Medicare for them has been plagued with problems.
Its causing a lot of difficulty for them, state Medicaid director Jerry Phillips said. We are concerned that they are having a lot more difficulty getting the drugs, and some of them may end up not getting the drugs.
He said lack of drugs could put many older people in the hospital or even endanger their lives.
Phillips said his agency employees are working with the Center for Medicare and Medicaid Services to get the problems ironed out so clients can get medications.
They dont have cards. They dont know what plan they are on. They dont recall receiving the information or being referred to a plan, Phillips said. Some are elderly and frail, and thats a real concern.
Department of Health and Hospitals spokesman Bob Johannessen said Medicaid offices in the state are reporting thousands of calls a day.
Johannessen said beneficiaries are having a hard time getting through to the services center to get their problems solved, so they are turning to state Medicaid offices for help.
State officials had sought a delay in the Medicare takeover of former Medicaid recipients, fearing hurricane relocations and upheavals would create problems, Phillips said. But the federal CMS wanted to stay on schedule, he said.
There was no immediate comment from CMS Ford Blunt in Dallas, a regional Medicare official who has been dealing with Louisianas problem.
Louisianas situation is not unique. According to news reports, low-income Medicare beneficiaries in some other states are being turned away from pharmacies without getting prescriptions.
Four states have decided to pay the drug bills of the low-income elderly until problems are ironed out Maine, New Hampshire, North Dakota and Vermont.
Earlier, CMS administrator Dr. Mark B. McClellan said his agency was working closely with states to help individual patients, noting that nearly 1 million patients were getting prescriptions filled per day many of them in the low-income range.
Phillips said if cash-strapped Louisiana covers clients during a transition period, the state would have to pay the total cost. He said officials are in negotiations with CMS on the issue.
The real emphasis has got to be getting these people drugs, he said.
The problems reported by Department of Health and Hospitals Medicaid field staff include:
Participating pharmacy plans said CMS has not sent them the lists of approved enrollees.
Informational letters CMS sent to Medicaid recipients apparently didnt work.
They (recipients) did not understand anything about Medicare Part D (pharmacy coverage) and did not know they were enrolled in a plan, much less which plan, one staffer wrote.
Many callers said they did not receive the CMS notices or new cards, possibly due to disrupted mail service since the storms.
Pharmacists are not willing to fill prescriptions even though they can call a phone number to insure medication is dispensed during the first 30 days of the program.
Pharmacies are making clients pay for medications and telling them they wont be reimbursed.
Some clients report that their medication is not covered/too expensive under their assigned plan.
Source: Advocate; Baton Rouge, La.
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