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Bush Officials Acknowledge Drug Program's 'Rocky Start'

Posted on: Thursday, 19 January 2006, 03:03 CST

By LARRY LIPMAN Palm Beach Post Washington Bureau

Bush administration officials Tuesday acknowledged that "tens of thousands" of Medicare beneficiaries have had difficulty buying prescriptions under the new drug program, but they said the federal government and private insurers are making improvements to correct the situation.

Responding to cries of outrage across the country from Medicare beneficiaries, state governors and members of Congress, Health and Human Services Secretary Michael Leavitt defended the administration's response, while acknowledging that problems are likely to continue until all beneficiaries in a drug plan have made at least one purchase.

"Some people are having problems getting their medicines and we're working with our partners to fix those problems," Leavitt said. "This is a new program. Some people may experience a problem the first time they go to get their medicines, but we're confident that, after you use it once, things are going to go more smoothly."

"It's been a real rocky start," said Michelle Herrle, pharmacist at The Village Pharmacy, located inside Century Village near West Palm Beach.

She said seniors have been rejected for drugs by drug plans or suffered from sticker shock because the co-payment was higher than they expected.

Federal officials said most of the problems center around low- income Medicare beneficiaries who previously had their drugs covered by state-federal Medicaid programs.

The Medicare drug law forced all of those so-called "dual- eligible" beneficiaries into private drug plans, which will receive a Medicare subsidy.

Problems have happened when beneficiaries attempt to fill prescriptions that are not covered by a private plan, or that require a hefty co-payment.

Leavitt said "tens of thousands" of cases have been resolved by pharmacists or beneficiaries calling Medicare for help on it's toll- free hot line at (800) 633-4227.

Herrle, however, said many dual eligibles didn't even know they have been enrolled into a Medicare drug plan, and much of the problem has been getting through to a drug plan by telephone.

"You could sit on hold for 90 minutes," she said.

In some cases, Herrle said the pharmacy has given a three- or four-day supply of drugs to customers until they can work out their problem with a drug plan.

Susan Ritchie, a pharmacist at a CVS store in Palm Springs, said the only troubles have been with dual eligibles.

The store now asks those patients who are unsure what plan they've been assigned to call Medicare and find out before the pharmacy can process their prescriptions.

Since the new drug program went into effect Jan. 1, several states have declared emergencies and stepped in to pay for drugs for low-income beneficiaries. Florida has not.

Dr. Mark McClellan, head of the federal Centers for Medicare and Medicaid Services, said the federal government would work with the private plans to ensure that states are reimbursed for those expenses.

Medicare officials during the weekend also ordered drug plans to take several steps to make it easier for pharmacists to fill prescriptions for dual-eligible beneficiaries without requiring hefty co-payments.

Those steps include providing pharmacies with direct contacts to customer service representatives who can make quick coverage decisions and permitting pharmacies to electronically submit claims that can be accepted in real-time.

During a 30-day transition period, drug plans also must provide any drug formerly covered by Medicaid to beneficiaries for a maximum charge of $5 even if the drug is not covered by the plan.

The transition period is designed to give beneficiaries time to switch to a different, but similar, medication or to appeal the denial of coverage.

In addition, Medicare has set up a toll-free line pharmacists can use to check whether a beneficiary is enrolled in a private plan.

If a pharmacist cannot determine which plan covers a beneficiary, the pharmacist can enroll the beneficiary in a "default plan" which will provide immediate coverage, Leavitt said.

"We're committed to fix every problem as quickly as possible and we'll do it as long as it takes, although we expect every day we'll see improvements," he said.

Leavitt said 2.6 million beneficiaries have enrolled in a drug plan within the past month, bringing the number covered by the Medicare drug law to 24 million - including about 11 million retirees covered by former employers and about 6 million beneficiaries in managed care plans.

Staff writer Phil Galewitz contributed to this story.

larryl@coxnews.com

New drug rules

This past weekend, Medicare ordered private drug plans to take these steps to prevent former Medicaid patients from being turned away without prescriptions or being charged exorbitant prices:

'

* Provide any drug formerly covered by Medicaid to beneficiaries for a 30-day transition period for a maximum charge of $5, even if the drug is not covered by the plan.

* Provide pharmacies with direct contacts to customer service representatives who have the authority to make quick coverage decisions.

* Permit pharmacies to electronically submit claims and have them accepted 'in real-time.'

Source: Palm Beach Post

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