State to Cover Drug Costs Due to Medicare Problems

By Rebecca Vesely, STAFF WRITER

California on Thursday joined a growing number of states that are stepping in to cover the prescription drugs of low-income seniors and people with disabilities who are having problems accessing Medicare’s two-week-old drug program.

Starting immediately, the state will temporarily pick up the cost of prescription drugs for 1 million people who are enrolled in both Medicare and Medi-Cal, said Kimberly Belshe, California’s Secretary of Health and Human Services.

These so-called dual eligibles saw their prescription drug coverage switched from the state to the federal government’s new program on Jan. 1.

Because of the scope of the problem,

Gov. Arnold Schwarzenegger issued an emergency order to cover the drug costs for the next five days. On Tuesday, the Legislature is scheduled to extend funding for an additional 10 days.

The cost to the state for the emergency program is estimated at $70 million, said Stan Rosenstein, administrator for Medi-Cal.

By the federal government’s own estimates, one in five dual eligibles — about 200,000 Californians — are having problems accessing the new program when they show up at pharmacies to get their drugs, Belshe said.

The state also will reimburse any dual eligibles who paid out of pocket since Jan. 1 for their drugs.

In those cases, people should return to the pharmacy where they got their prescriptions filled and try once more to access the new federal program. If unsuccessful, they can get reimbursed by the state immediately, Rosenstein said.

“People should not have to bear any cost beyond a $1 to $3 co- pay,” he said.

Calling the new federal program “challenged and troubling” at a news conference announcing the emergency order, Belshe said she expects the state to be reimbursed by the federal government for covering these costs.

“This in no way mitigates the federal government’s responsibility,” Belshe said.

“Governor Schwarzenegger intends to aggressively pursue reimbursement from the federal government.”

Belshe added that she believes the federal government is working hard to resolve the problems as quick as possible.

Jeff Flick, regional administrator for the Centers for Medicare and Medicaid Services, which is overseeing the new federal drug program, said the state would be compensated. “We are going to work very closely with our state partner to recover any funds that are expended here,” he said.

Pharmacists, many who are overwhelmed by a bureaucratic nightmare, said they appreciated the state’s action.

“This is something that really needed to take place,” said Lynn Rolston, CEO of the California Pharmacists Association.

Among the problems being reported are that patients enrolled in the new program aren’t showing up on computer databases, and others haven’t received cards from new insurers proving that they have coverage. Some people’s drugs aren’t covered at all or they carry exorbitant co-payments.

Dual eligibles are low-income seniors and disabled who previously paid nothing for their prescription drugs under the Medi-Cal program.

Other states that have launched emergency programs to cover the drug costs include Illinois, Arkansas, Massachusetts and Connecticut.

The Associated Press contributed to this report.