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Program Tests Local Pharmacists' Patience: MEDICARE PRESCRIPTION DRUG BENEFIT

Posted on: Saturday, 21 January 2006, 12:00 CST

By Karen Vigil, The Pueblo Chieftain, Colo.

Jan. 21--One Pueblo pharmacist says he thinks the wrinkles of the Medicare drug assistance plan are beginning to smooth.

But another longtime pharmacist says enrollment problems continue with the most vulnerable of the population going completely without prescription coverage.

Jim Sajbel, pharmacist-owner of Prescription Shop, 915 W. Northern Ave., called program the worst pharmacy-related effort - the "worst government boondoggle" - he's seen in his career.

"It's going horrible," Sajbel said.

The drug assistance program went into effect Jan. 1.

"We have been on phones for five hours every day trying to get these programs to go through for our patients. We can't talk to insurance companies. Their lines are inundated," Sajbel said.

By contrast, pharmacist Eric Yoxey, manager of Broadway Pharmacy, 101 Colorado Ave., said he thinks the program is going "about 50 percent better" since Jan. 1.

Yoxey said he thinks the biggest problems came right on Jan. 2 because a huge crunch of people waited to enroll after the new year began, backing up telephone requests for help at pharmacies, insurance companies and Medicare offices, sometimes for hours.

Broadway's approach to enrolling senior citizens and the disabled has been to advise clients to handle more of their own research and decision making, he said.

Yoxey cited two main problems confronting enrollees: obtaining an I.D. plan number and/or finding themselves automatically enrolled into an insurance plan that does not carry the medication they need.

"People were placed into (inappropriate) plans so adjustments are going to have to be made. And there are drugs that are just not covered any more," he said.

Subsequently, he said, doctors either have to figure out substitute drugs that are covered or call the insurance companies and get the enrollees approved to use the drugs they need.

Sajbel said the problems he sees go further.

Not only are pharmacists spending hours a day on the phone with insurance companies and Medicare, he said, but they are getting paid less for their work. Medicare cut pharmacists' reimbursement rate for filling prescriptions as part of the new drug plan, Sajbel said.

Elsewhere, for some people who were dual Medicaid/Medicare enrollees such as developmentally disabled in assisted living facilities who are unable to advocate for themselves, Sajbel said "the Medicaid stopped paying" and the "dual eligibles" have no idea what to do next.

"Now they have no insurance. We're trying to get them through the system but we can't get through the (telephone enrollment) systems. I am on the phone for two hours and then I am cut off (from the connection).

Sajbel said he's helping the developmentally disabled by carrying $5,000 of medication on his books and hoping he'll eventually be reimbursed.

He said he is so concerned about how the current drug assistant program is playing out and the Medicaid changes coming on Jan. 1, 2007, that he's encouraging people to contact their state and federal elected representatives and voice their complaints.

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Copyright (c) 2006, The Pueblo Chieftain, Colo.

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Source: The Pueblo Chieftain

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