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State Hopes Crisis Resolves Itself; Some Pharmacists, Others Say Medicare Drug Plan is a Failure

Posted on: Thursday, 19 January 2006, 03:00 CST

By KRIS WISE

DAILY MAIL CAPITOL REPORTER

While other states are stepping in to pay drug costs for patients caught up in problems with the new Medicare prescription program, West Virginia officials are adopting a wait-and-see stance.

Department of Health and Human Resources administrators said they expect to make a decision in the next few days about whether to pay drug costs for patients who aren't getting proper benefits through the new and struggling federal system. They said they believe problems with the new drug coverage are limited and will work themselves out soon.

Senior representatives and pharmacists, however, say the Medicare plan is a widespread failure that has left people throughout West Virginia with no coverage or the wrong kind of coverage.

The state Bureau of Senior Services is taking 40 to 50 phone calls each day from seniors who aren't getting the right benefits and are having to pay out of pocket for drugs that should be covered under the plan.

"Our lines stay busy," said Linda Calvert, director of the state health insurance assistance program for the Bureau of Senior Services. "We're getting calls from all over the state. There is just a myriad of concerns and problems."

The new Medicare drug coverage kicked in Jan. 1, but people around the country are having trouble. Many who signed up find they aren't listed in pharmacies' computer systems as a participant, or they're asked to pay hundreds of dollars for medicine that Medicare mostly should cover.

"A big part of it is that the drug plan is still charging the wrong co-pays," Calvert said Monday. "People who are eligible for full assistance who should only be paying a couple of dollars are getting these huge bills."

Some pharmacies have been forced to take matters into their own hands.

Clendenin pharmacist Bill Ore has started handing out free five- day doses of prescriptions to customers who haven't yet received their new Medicare prescription card or who have been caught in system hang-ups.

Ore said he wasn't going to charge his customers more money now because the federal government made a mistake, and he will back- charge Medicare for the five-day supplies once the plan is worked out.

"We've been here for 32 years and we know everybody by name and we just wouldn't do that," said Ore, who owns and operates the Clendenin Pharmacy. "Probably at a lot of places people are having to pay out of pocket, because a chain pharmacy just can't do this for everybody."

States including California, Illinois, Arkansas and about a dozen more already have decided to pay the prescription costs for people who've experienced problems at the pharmacy because of the new plan. At least for the next two weeks, pharmacies with customers who aren't registered in the system or who have the wrong co-pays can bill the state for the drugs.

In some of the largest states, the cost could amount to more than $2 million a day.

State Department of Health and Human Resources spokesman John Law said the office would decide in the next few days whether it is necessary to step in and pay similar charges.

"There seems to be a disconnect as to how bad the problem is here," Law said Monday. "We don't see quite as much of a problem around the state as some pharmacies here have reported. Many times, these problems will work themselves out in short period of time."

Law said the state hasn't figured out how much money it might cost per day to temporarily pay for the drugs until the Medicare mishaps are wrapped up.

"What we're looking at is if the federal government doesn't pay or doesn't come up with some (reimbursement) plan, which it hasn't, that's all state dollars," Law said.

The state already is paying the tab for about 4,000 West Virginia residents who are eligible for both Medicaid drug coverage and Medicare.

"The federal government is charging us for supplying drugs to these people, so right now we're paying for these drugs and the people aren't getting them," Law said.

State officials said no Medicare recipient should have to leave a pharmacy without a prescription they need.

If the pharmacist can't help with enrollment or co-pay problems, state services are available.

The state Bureau of Senior Services opened its call center in November to hear all sorts of problems from seniors. Since the Medicare drug plan came on line, at least one person has been assigned solely to resolving the most serious prescription problems.

"Any time a case is urgent, we are giving it priority and we are getting some cases resolved the same day," Calvert said. "We just ask that people be patient and persistent. The problem is that people get personalized assistance, but it can be time consuming."

Ore, the Clendenin pharmacist, said working out coverage issues with Medicare's participating insurers hasn't been easy.

Some of them have been so busy with complaints that they've temporarily stopped taking calls. Others have told him to call within a very specific and inconvenient time frame, like 7 p.m. to midnight.

Many of Ore's customers haven't even received their Medicare drug cards, which were supposed to be shipped out before Jan. 1.

"They just didn't prepare for this at all, and it's made it terrible for us," Ore said. "Things seem to be smoothing out, but for the most part nobody had any idea what they were doing. I'm tired and I'm frustrated."

To report a problem with the drug coverage, call the Bureau of Senior Services call center at 877-987-4463.

Contact writer Kris Wise at kriswise@dailymail.com or 348-1244.

Source: Charleston Daily Mail

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