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Medicare Rx Benefit Descends into Chaos

Frail Seniors Without Vital Medicine; Washington Slow to Act

January 8, 2006

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The first week of Medicare's new prescription drug benefit is being described as chaotic for pharmacies and an outright disaster for the elderly poor.

Reports from around the country indicate that it is primarily elderly citizens on Medicaid who are feeling the most severe impact.

The new benefit, which began enrollment last fall but went into effect January 1, offers Medicare recipients a choice of private insurance programs to subsidize the cost of their prescriptions. Participation is optional, at least for most Medicare recipients.

"For the almost seven million persons who are eligible for both Medicare and Medicaid, the participation in Medicare Part D for these current Medicaid beneficiaries is hardly optional," said the National Senior Citizens Law Center.

"These dually eligible people have no alternative coverage for their prescription drugs, so they must enroll in the program, go without prescription drugs, or try to pay the full cost of their medications on meager income."

That's because, to help pay for the new entitlement, Congress moved portions of Medicaid, a program to provide health care for low-income Americans, into the new "optional" program. The elderly poor, who had been getting their drugs through Medicaid, now have to participate in Medicare"s new drug benefit program, called Medicare Part D.

The NSCLS says it's not surprising problems have surfaced in the program"s first week, since those most impacted by it are among society's most vulnerable groups and have the most medical needs.

When Medicaid recipients began arriving at pharmacies around the country last week, they often lacked benefit cards and other records to show what plans they belonged to. Because there was a crush of plan enrollments in December, officials say many people who were late in signing up may not have had their paperwork processed.

That's led to major confusion at the pharmacy counter. Fadi Atiya, a pharmacists and store owner in San Diego, told the San Joe Mercury News that more than half of his customers are elderly poor, and that he has been unable to verify enrollment for most of them because of back-ups in Medicare phone lines.

Atiya said he has been filling prescriptions without compensation and hopes he will be reimbursed.

Expressing alarm at the chaos, several states have taken action to make sure their citizens continue receiving prescribed medication. In Vermont, Governor Jim Douglas announced the state would pay drug costs for Medicaid recipients until Washington fixed the problem.

In Vermont, the state legislature last week declared a public health emergency, due to the federal implementation of the drug benefit. Lawmakers expressed concern that state residents were being turned away at pharmacies without the drugs they need.

In Alabama, the Montgomery Advertiser reports pharmacies around the state are having similar problems. "The (insurance) companies weren't prepared for us," Joe Street, a pharmacist at Adams Drugs in Wetumpka, told the newspaper. "It was a bigger load than they thought it was going to be."

The situation is reported to be particularly bad in Maine. With angry pharmacists and Medicaid recipients jamming state house phone lines, the state government ordered pharmacists to bill the state for prescriptions for elderly patients whose claims couldn"t be processed.

While intense pressure is likely to focus on Medicare administrators in the coming week, thus far there has been little sign of urgency at the federal level in addressing the problems.

Larry Kocot, senior policy adviser to the Medicare Plan Policy Group, says there have been many successes in the plan's first week, but that "transition is never without challenges."

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