Problems with New Medicare Drug Benefit Persist

Medicare's new drug benefit is on target to reach its enrollment goal, federal officials said Tuesday. But state officials and patient advocates say problems with the program aren't getting solved fast enough.

After two weeks on the defensive, answering questions about computer glitches and jammed customer service lines, Health and Human Services Secretary Mike Leavitt finally had some good news to report.

"We had 2.6 million more enrollees (sign up) during the last 30 days," Leavitt told reporters. "That comes on top of more than one million that enrolled in the first 30 days of the program and brings the total to nearly 24 million beneficiaries with prescription drug coverage."

Most of those 24 million, however, don't have new drug coverage. Their health plans or former employers are simply accepting a government subsidy to continue the coverage already being provided. For hundreds of thousands of others, things are still anything but smooth.

"This plan was supposed to provide coverage for people who had no drug coverage. It was supposed to help some of our lower income people," said Jeanne Finberg, supervising attorney for the National Senior Citizens Law Center.

Instead, she says, it has taken away access for some of those who most need it — some 6.4 million Medicare beneficiaries who had, until Jan 1, gotten their drug coverage through the Medicaid program.

"These vulnerable seniors and people with disabilities had good coverage under Medicaid," Finberg said. "Now they are in danger of dying because they cannot get access to their medically necessary prescription drugs."

HHS Secretary Leavitt acknowledged that there have been problems. "When there's change, there's an opportunity for things to go wrong," he said. "We're fixing them one pharmacy, one beneficiary, one state at a time."

But Leavitt and Mark McClellan, administrator of the Centers for Medicare and Medicaid Services, insisted that they have put in place enough protections that everyone should get taken care of the first time. "If you are a Medicare beneficiary having difficulty at the pharmacy counter, don't leave without your prescriptions or contact us right away at 1-(800) MEDICARE for help," McClellan said.

The situation is improving, says Alabama Medicaid Director Carol Herrmann-Stecker. Alabama is one of 26 states that have stepped in to pay for drugs for low-income patients who can't get their new Medicare plans to work. "We're starting to see the systems that should have been in place on January 1 are being put in place," she said.

But Herrmann-Stecker cringes when she hears federal officials telling patients not to leave the pharmacy without their drugs.

"It is very unrealistic," she told NPR. "I would invite Dr. McClellan and the secretary to sit behind a pharmacy counter and experience what our pharmacists are experiencing — long waits to get through to any of the help lines that have been set up. It is extremely difficult for the pharmacists."

And advocates like Jocelyn Guyer of Georgetown University say it's inappropriate for federal officials to be touting how well the program is working for most people.

"To me it's a little bit like an airline company that's had multiple crashes saying that things are going well because it's successfully landed dozens of planes," Guyer said.

It's not just advocates who worry about the program's future. Some business analysts are concerned as well. They note that only about 17 percent of those eligible for the Medicare drug benefit have enrolled themselves in a plan. That's not nearly enough yet to make the private plans financially viable.

"Having only 3.6 million out of 21.3 million at this point is of concern," said industry consultant Robert Laszewski.



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