Problems with the new Medicare prescription drug benefit have now prompted 19 states to step in to guarantee coverage for their low-income residents. And while the federal government, pharmacists and private insurers struggle to fix the glitches, the blame game is starting as well.
Pharmacist Richard Logan has been serving patients on the same block in Charleston, Mo., population 5,000, for more than 30 years. But he says nothing compares to the problems he's had with the new Medicare drug benefit. "It has just been extremely frustrating. I have never, ever been in a position that I could not take care of my patients. And that's the position for the last 10 days that Medicare has put me in."
Logan lives in a rural part of the state where incomes are low, so he serves a lot of patients who until Jan. 1 got their drugs through the Medicaid program. He says the transition to Medicare coverage has been particularly hard for them. He had one low-income patient with diabetes and emphysema, he says, "whose co-pays, after we discovered he was in the computer system somewhere, would have cost him $300 to walk out of the pharmacy with his medicine."
Logan gave the man his pills for free until coverage was straightened out. Then there was the cancer patient, whose name showed up correctly in the computer, but whose prescription couldn't be approved. Logan tried repeatedly to call to get the problem straightened out, but "we could not talk to a person. Anytime we tried to call the phone lines were busy, they hung up on us, told us to call back after 7 o'clock at night or before 9 o'clock the morning. And we would start at 7 a.m. calling and get the same message. This went on for about four days."
By the time Logan got the man's problems worked out, he'd missed at least four doses of his chemotherapy.
Pharmacists reported similar problems in Maine, says Jude Walsh, the state's pharmacy director. There were other problems as well, including for patients in nursing homes. In some cases, residents in Maine nursing homes were assigned to drug plans in other states. "If people who are in nursing homes have a guardian, a lot of time what's happened is they were assigning plans to people based on a guardian address," In some cases those guardians live in Pennsylvania or West Virginia, she says, and patients were assigned to plans there, "and there's no way that person can get a pharmacy in Maine to cover their prescription drug."
Maine stepped in early to guarantee — with state money — that low-income patients will get the medications they need. Walsh says Maine has already paid for 68,000 prescriptions, at a cost of more than $3.5 million.
But that's a fraction of what California is facing. With a million people eligible for both Medicaid and Medicare — one of every six such beneficiaries in the country — California officials estimate the state could spend $70 million to backstop the program over the next three weeks.
Kimberly Belshe is California's Secretary of Health and Human Services. She says she and Republican Gov. Arnold Schwarzenegger believe federal officials when they says they're working to correct the problems, "but the governor felt that we really couldn't wait; and that is why we need to move forward with temporary emergency coverage to make sure people in need get the medical services, the prescription medications that they terribly need."
Mark McClellan, who runs the Medicare and Medicaid program from Washington, says things are getting better. "Every day we're seeing more and more people get their prescription drugs smoothly, and we have other steps in place to make sure that anyone who is having difficulty can get the drugs they need."
Those steps include thousands of new operators for the hotline that takes calls from pharmacists, as well as a plan pharmacists can bill for patients who did not get properly enrolled.
Missouri Pharmacist Richard Logan agrees things have improved in the last few days — but not much. And he says federal officials should have anticipated the problems. "This has been coming on for two years now. Whoever was not expecting this — I just keep remembering, this is the same government that brought us FEMA."
And the problems are already taking on partisan overtones. Friday night, three-dozen Senate Democrats sent a letter to Health and Human Services Secretary Mike Leavitt, demanding an accounting of all the preparation steps the administration took to facilitate the transition from Medicaid to Medicare drug coverage.