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Calls for Help With Medicare Drug Program Growing, Advocates Say

Posted on: Wednesday, 11 January 2006, 21:00 CST

PHILADELPHIA _ Nearly two weeks after it began, the new Medicare prescription drug program remains plagued by problems, and calls for help are growing, advocates report.

Many elderly and disabled patients have been unable to get medicine since the program's kickoff on Jan. 1, according to interviews with medical professionals and public-interest lawyers.

In one case, a man who recently had his leg amputated cannot get Medicare to cover the antibiotics he needs to stop a life-threatening infection, according to lawyers for Community Legal Services. In another case, a woman with lung cancer was turned away from her first chemotherapy treatment because of a Medicare mixup.

"There are breakdowns at every point and there is no one there to fix them," said Michael Campbell, executive director of the Pennsylvania Health Law Project.

Calls for help to Pennsylvania's health insurance hotline have reached record levels, and several pharmacists said they have never seen greater chaos.

"This is not getting better. It's getting worse and it's an outrage," said Sam Brog, executive director of the Philadelphia Association of Retail Druggists. "They should end the program and start over."

Lorraine Ryan, a Medicare spokesperson in the Philadelphia office, said the agency is "concerned about people encountering difficulties getting medication."

She said the agency has identified a computer glitch that caused several hundred thousand of the poorest recipients nationwide to be overcharged and go without their drugs. She said the agency is working on the problem.

She called the overall number of complaints "small" compared to the millions who have already been helped. But she said "it is unacceptable that anyone is not getting medication or benefits."

Medicare drug coverage, the biggest expansion of the program in its 40-year history, began Jan. 1. The federal government expects the new benefit to cut average drug costs by 50 percent for all 42 million Medicare beneficiaries.

But only about 1 million people had voluntarily signed up by late December.

By Wednesday, six states, including New Jersey, have acted to pay for temporary supplies of medicine for Medicare patients.

In New Jersey, officials suspected months ago that some problems would occur. So they set up a safety-net plan to pay for medications if eligible people became stuck in the new system.

But the scale of the complaints has surprised them. "We saw by Friday that this was mushrooming into a bigger problem than we had imagined," said Suzanne Esterman, a spokesperson for the New Jersey Department of Human Services. "We saw we had to step in and make sure no one would go without drugs."

New Jersey has spent more than $6.4 million to fill about 69,000 prescriptions since the federal program began, Esterman said.

Sen. Frank R. Lautenberg, D-N.J., said through a spokesman that he plans to introduce an emergency measure to force the federal government to reimburse states that have paid for drugs.

In Philadelphia, some patients said their emergency supplies are growing short.

Thomas Tucker, 59, of East Falls in Philadelphia, has tuberculosis and spends his days tethered to an oxygen machine. A Medicare recipient because of his disability, he needs drugs to help his inflamed and scarred lungs absorb more oxygen.

"I get light headed, my breathing gets shallow and it feels like I'm getting cut off," he said.

He and a cadre of nurses, social workers and lawyers have tried to get his three medications since he was released from the hospital 10 days ago _ to no avail.

"If a team of people who understand the system as well as we do can't help him, who can?" asked Mary Beth Hardiman, a nurse with The Visiting Nurse Association of Greater Philadelphia, a nonprofit that provides home health care to poor patients.

To be sure, many Medicare recipients will benefit greatly from the new program.

Although there are no hard numbers, health experts on the front lines said the number of patients seeking help continues to rise.

"Our call volume this week is the highest it's ever been," said Jack Vogelsong, who runs Pennsylvania's insurance information program in the Department of Aging. "People are not getting what they were promised."

Even health professionals and lawyers who pride themselves on knowing the inner workings of Byzantine government programs said they are frustrated by the complexity and scope of the problems.

Campbell, of the health law project, said his agency is trying to help patients, but can't get through to the right officials to find answers. They have been receiving about 120 calls per day this week.

"We're a group of lawyers who have jumped in, because it's a real crisis," he said.

In many cases, pharmacists have become the only salvation for patients desperately in need of medicine. But they, too, have been stymied by long waits and unanswered phone calls.

"I've been a practicing pharmacist for 21 years and this has been the worst two weeks of my life," said Dave Ostrow, the owner of Cambria Pharmacies Inc. in North Philadelphia.

His frustration is shared by Bob Schreiber, a pharmacist for 35 years and owner of Burns Pharmacy in Morrisville, Pa.

"If you get through to CMS, they can't tell you anything because they are untrained and don't know how program works," Schreiber said.

What pharmacists, telephone operators and providers don't face is the fear Tucker stares down each day as his supply of drugs dwindle.

Tucker heard about the new drug program, but thought his old Medicaid plan would continue.

After getting released from the hospital for severe breathing problems on New Year's Eve, he called his pharmacy to get his medications, but was told his coverage no longer worked and they had no record of his new plan.

He then called his new insurer, who told him he was not eligible until Feb. 1.

Since then a team of people have been trying to sort out the delay.

His doctor gave him a small supply of medication to tide him over, but that is running low.

"What should I do then?" he asked. "I have all these people helping me. What about someone who is going it alone?"

Some of those people are calling Pam Walz, director of the Elderly Law Project of Community Legal Services in Philadelphia.

"This is a disaster unfolding quietly out of public view in the homes of the poor and disabled," she said.

___

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Source: The Philadelphia Inquirer

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