Medicare Rx Plan Denies Meds to
Elderly
Washington Post/AP
By KEVIN FREKING
The Associated Press
Saturday, January 14, 2006; 9:20 PM
WASHINGTON -- Tens of thousands of elderly poor people may have had trouble
getting their medicine during the first two weeks of the government's
prescription drug benefit, and about 20 states have been forced to step in to
help them, the top Medicare official acknowledges.
The problems will be fixed, pledged Mark McClellan, administrator for the
Centers for Medicare and Medicaid Services, in an interview with The Associated
Press.
In some cases, people are not showing up in databases as being enrolled in a
plan. When they do show up, many people are being told they need to pay
hundreds of dollars before they can get their medicine. Instead, they should
owe only nominal amounts.
"I'm working with the states, with the plans, with all of our partners to
make sure people get the prescriptions they need," McClellan said Friday.
Under the program, about 42 million disabled and older people are eligible
to enroll in private plans that will subsidize their prescription drug costs.
Millions of prescriptions have been filled without trouble, McClellan said, but
there is growing concern that some of the poorest beneficiaries cannot get
their medicine.
Some advocacy groups say they believe McClellan underestimated the
problems.
"We could see the problems coming. We expressed concern, and it was just
pooh-poohed. Now, our worst fears have been realized," said Jeanne Finberg, a
lawyer with the National Senior Citizens Law Center, which is based in Oakland,
Calif.
The problems go beyond technical difficulties, such as when computer
databases fail to note that a beneficiary is enrolled in a plan. In some cases,
private plans are just not following guidelines established for their
participation.
The plans are not issuing emergency supplies as required and they have set
up prohibited restrictions on the types of medicine that beneficiaries can get
during the first weeks of the program, according to the American Psychiatric
Association.
"Relapse, re-hospitalization and disruption of essential treatment are some
of the consequences of the bureaucratic nightmare," said the association's
president, Steven S. Sharfstein. "I commend those states and other
jurisdictions that have taken steps to assure that patients receive their
medications in a timely manner."
McClellan said he has directed plans providing drug coverage to make it
easier for pharmacists to resolve questions about a beneficiary.
"I've been in touch with the health plans today and they are setting up
expedited processes for pharmacists to contact a plan without waiting in a long
queue. The plans are setting up those systems right now," he said.
McClellan said plans were required to provide a 30-day supply of drugs, even
if their plan does not cover a particular drug. In cases when a drug is not on
the list, plans require pharmacists to get pre-authorization before dispensing
the drug. Many plans are waiving the pre-authorization requirements, he
said.
The agency also updated information on Friday so pharmacists can more
quickly reach plans, McClellan said.
McClellan also said he contacted several governors and the staff of the
National Governor's Association this past week on how best to help
beneficiaries. Some lawmakers have demanded that the federal government
reimburse states for those efforts, but McClellan said the insurers and other
businesses offering coverage would do that.
"The plans are getting paid additional amounts to provide the extra coverage
for the dual eligible beneficiaries. It's a matter of reconciliation," he said.
"If the state works with us ... we can send that information onto the plan so
the plan reimburses the state for the difference."
Democratic lawmakers wrote Health and Human Services Secretary Mike Leavitt
on Friday with dozens of questions about the new program.
"We want to know why so many of our constituents have fallen through the
cracks during implementation of the Medicare prescription drug benefit, and we
urge you to take immediate action to correct the problems," the lawmakers
said.
A spokeswoman for Senate Majority Leader Bill Frist, R-Tenn., sounded a more
optimistic note.
"We are pleased with the successes of the program and are working with (the
Health and Human Services Department) to resolve the problems, which will
naturally occur when implementing a program of this magnitude," spokeswoman Amy
Call. "But at the end of the day seniors will have better access to
prescription drugs."
McClellan said Medicare also has caseworkers on hand for beneficiaries or
pharmacists who are having trouble navigating the new benefit. They can call
1-800-Medicare for help, he said.
On the Net:
Medicare: http://www.medicare.gov
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