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Extended Medicare Drug Help is Sought

Posted on: Thursday, 16 March 2006, 12:00 CST

By Nancy Weaver Teichert, The Sacramento Bee, Calif.

Mar. 16--Advocacy groups are urging state officials to provide a permanent safety net for senior and disabled Californians who have trouble with Medicare's new drug plan. Low-income and chronically ill people still have trouble getting needed medications through the plan, about 25 groups said at a news conference Wednesday. The groups included the California Alliance for Retired Americans, California Health Advocates, Congress of California Seniors and the National Senior Citizens Law Center. The groups want Medi-Cal to provide ongoing coverage of last resort for new enrollees who run into problems and to cover the co-payments that beneficiaries now pay under the new federal drug coverage. "The state must act to protect its most vulnerable citizens," David Lipschultz, an attorney with Health Advocates, said of the nearly 1 million Californians who were automatically switched from Medi-Cal to Medicare's new drug plan on Jan. 1. "The need is more than temporary." Lipschultz estimated that about 180,000 of those people have depended on Medi-Cal's emergency provision of prescription drugs. That emergency coverage is scheduled to expire Friday, although the governor is expected to extend it until May 16. A Governor's Office representative had no comment on the request for a permanent safety net. So far, Medi-Cal has filled 567,682 prescriptions at a cost of $38 million, which state officials have asked to be paid back by Medicare. At the end of March, the drug plans will end transition coverage, which allowed people to get automatic refills of drugs they had previously taken even if those drugs weren't covered by their new plan. Advocates worry that unless permanent backup is provided, there will be a repeat of the problems in January that left people without lifesaving drugs. Every month, 10,000 people enroll or switch plans and may run into the same problems, they said. Medicare's private drug plans are working better than they were, but advocates say many people still encounter inaccurate coverage and co-payment information. "I'm exhausted and I'm helpless," said Toni Vargas, a consumer advocate with the Health Consumer Center of Los Angeles, who said it takes days or weeks to work out problems for patients. Even if the plans work well, people who used to get drugs from Medi-Cal are still worse off under Medicare, said Lipschultz. They were forced into private drug plans that cover only approved drugs, may require prior authorization or step therapy to get some drugs they used to take, may limit quantities and may charge them co-payments of $1 to $5 per prescription that they didn't pay under Medi-Cal. Judy Jackson, a retired teacher in Berkeley who has severe asthma, said her co-payments total $70 in the winter. Her plan also required her to try eight inhalers that she was allergic to before she could get her preferred medication. "Right now, it's coming down to food or co-pays," Vargas said of low-income beneficiaries. Margaret Reilly, assistant director of the Health Insurance Counseling and Advocacy Program, HICAP, in Sacramento, was unable to attend the news conference. But she agreed with the advocates' concerns. She said people often call for help because they can't afford co-payments for 10 or 15 prescription drugs. She's also worried that those getting medications through emergency coverage don't realize that it will end soon. Earlier this week, President Bush touted the new benefit. He conceded there have been implementation problems but said they are being fixed. Democrats have pushed for an extension of the May 15 deadline for all Medicare beneficiaries to sign up for the voluntary coverage or face lifelong penalties. Bush opposes an extension. ------------ DEADLINES NEAR FOR COVERAGE Important Medicare dates: -- Friday: This is when emergency coverage for Medi-Cal recipients having difficulty obtaining drugs through Medicare is scheduled to expire. Gov. Arnold Schwarzenegger is expected to further extend the coverage until May 16. -- March 31: This is the end of the extended transition period for those who enrolled early in the program. The transition period provides an automatic refill of drugs not covered by the plans to give extra time to change prescriptions or request an exception. Those who sign up now will have a 30-day transition period. -- May 15: This is the deadline for all Medicare beneficiaries to enroll in any of the private drug plans providing coverage, with benefits starting the first day of the next month. Late enrollment could mean a 1 percent penalty per month for every month you were eligible for coverage and did not sign up. The penalty will be added to your premium each year for as long as you have Medicare prescription drug coverage. Source: California Health Advocates

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Source: The Sacramento Bee

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