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Wisconsin to Help Poor Pay for Medicare Drugs; Glitches in Federal Program Prompt Stopgap Aid

Posted on: Saturday, 14 January 2006, 15:00 CST

By GUY BOULTON

The state will temporarily pay for prescription drugs for some low-income seniors and people with disabilities under emergency measures taken Friday to address problems with the new Medicare prescription drug plan.

The move, announced by Gov. Jim Doyle, is designed as a stopgap while glitches in the new federal program are worked out. Other states have taken similar steps.

The state Department of Health and Family Services, pharmacists and advocacy groups say thousands of people in Wisconsin have had trouble getting their prescriptions since the Jan. 1 start of the Medicare drug plan.

The most widespread problems have been among the more than 110,000 people who are eligible for Medicaid as well as Medicare and were automatically enrolled in the new program.

Medicare is the federal health care program for people 65 and older or those who are disabled. Medicaid, a state and federal program, pays for medical expenses not covered by Medicare if someone is impoverished. To be eligible for Medicaid, an individual's income generally can't exceed $9,570 or less than $800 a month.

"The poorest of the poor, who were assigned to a plan automatically, were the ones who had to test a system," said Helene Nelson, secretary of the Department of Health and Family Services. "And the system didn't work."

The state will seek reimbursement from the private companies that are administering the prescription drug plans, Nelson said. Those eligible under the emergency measures will receive a 30-day supply of their prescriptions.

Praise for decision

Pharmacists, as well as advocates for seniors and the disabled, applauded the state's decision.

"Up to now, I haven't had a piece of good news since Jan. 1," said Aimee McCutcheon, an attorney for the Wisconsin Coalition for Advocacy.

On Monday, that group and the Coalition of Wisconsin Aging Groups asked the state to temporarily pay for the drugs of people who qualify for Medicaid.

"The state is stepping up to the plate to help these patients and the pharmacists," said Tom Engels, a spokesman for the Pharmacy Society of Wisconsin. "But it's a temporary fix."

Pharmacists have railed against the companies administering the prescription drug plans for long wait times when calling their help lines.

Susan Sutter, co-owner of Marshland Pharmacies in Horicon and Mayville, about one hour northwest of Milwaukee, said one of her employees was on hold for four hours Thursday.

A variety of problems

Common problems include people incorrectly enrolled in plans, requiring them to pay incorrect co-pays, people who cannot be found in a drug plan's computer system, and drugs that are not covered by a plan, Sutter said.

She estimated that 40 to 50 customers have been caught up in the problems.

The new drug plan the most sweeping change in Medicare's history was designed to make prescriptions more affordable for people eligible for Medicare.

The program has been criticized for its complexity. It also has become a political issue. And Doyle, a Democrat, strongly attacked the program in announcing the state's move.

"It is outrageous how the federal government has mishandled this program and put thousands of lives at risk," Doyle said in a news release.

Busting their chops'

Bob Herskovitz, a spokesman for the Centers for Medicare and Medicaid Services, said the worst problems have involved people who are eligible for both health programs. He said the agency's information technology experts are working to address those problems.

"They are busting their chops," he said.

The agency also has put in place measures to ensure that people get at least a temporary supply of medication.

Plan administrators blamed

Much of the criticism has been directed at the 17 private companies that administer the new drug plans in Wisconsin.

Sutter of Marshland Pharmacies, for instance, said her staff had not been able to reach Humana since the program began.

"We clearly recognize we have had some issues with the implementation of this program," said Larry Rambo, chief executive officer of Humana Inc.'s operations in Wisconsin and Michigan.

For their part, the companies have moved to increase staffing on their help lines and taken their own emergency steps to get people their drugs.

Humana, for instance, has told pharmacists to charge minimum co- pays of $2 for generic drugs and $5 for branded drugs when they do not have specific information on someone enrolled in one of its plans.

Wait time not acceptable'

Dean Health Plan in Madison also has taken steps to improve its staffing and help lines for pharmacists and customers.

Ed Pattarozzi, vice president of sales and marketing for Dean, said the average wait on its help lines was 9 1/2 minutes. Its lines are open from 7 a.m. to 6 p.m.

That's far below reports of pharmacists being on hold for hours. Still, Pattarozzi said, "That's not acceptable from our viewpoint."

The company has added telephone lines and staff in the past week.

Dean also is working on problems encountered by about 200 of the 9,000 people automatically enrolled in its prescription drug plan.

"In any new program launched," he said, "there are some issues that have to be addressed."

STATE STEPS IN

After two weeks of confusion in the federal Medicare drug plan:

-- The state will pay for a 30-day supply of prescription drugs for some people eligible for Medicare and Medicaid.

-- Reimbursement will be sought from the private companies administering the federal program.

Copyright 2006, Journal Sentinel Inc. All rights reserved. (Note: This notice does not apply to those news items already copyrighted and received through wire services or other media.)

Source: Milwaukee Journal Sentinel

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