Medicare Drug Benefit: A Two-Month Report Card

This week marks the two-month anniversary of Medicare's new prescription drug benefit. Politicians are either proclaiming the program a resounding success, or a spectacular failure, depending on their party.

For example, Virginia Democratic Congressman Jim Moran told a group of seniors last week that there's a good reason the drug program is so expensive and confusing. "It is a law that was largely, in our view, written by the drug companies, for the drug companies, and seniors and taxpayers are left footing the bill," he said. Moran's meeting was one of more than 100 Democrats are planning to highlight the program's flaws.

But Republicans, not surprisingly, disagree about how the program is progressing. President Bush praised the plan in his weekly radio address Saturday. "More than 25 million people with Medicare now have prescription drug coverage, and hundreds of thousands more are enrolling each week," he said. "This new coverage is saving seniors money on their drug premiums: The typical senior will end up spending about half of what they used to spend on prescription drugs each year."

People who are actually dealing with the drug plans on the ground have a more nuanced view. Sue Wolf Nelson is director of the Family Health Care Pharmacy in Fargo, N.D. It's part of a community health center that serves mainly low-income and uninsured patients. Nelson says that things were getting better for a while, but now some of the same low-income Medicare patients whose problems pharmacists struggled to straighten out in January are experiencing the same problems all over again. "For instance, their co-pays may have been wrong initially, then corrected, now we're back to wrong again. So we're having to readdress all the same things, which is a little frustrating to face again," she said.

Some people whose problems were straightened out are doing OK. Among them is Washington, D.C., resident Pearl Hewitt, who takes medications for a variety of illnesses, including cancer. The first time she tried to use her new plan, Hewitt — who's covered by the Medicaid program for the poor as well as Medicare — was charged far more than she was supposed to pay — and more than she could afford. Staffers from the District of Columbia's health insurance counseling program stepped in, and now Hewitt reports she's doing fine. "What I do is give them my prescription and show them my card, the little card they gave me, and evidently they must have got me in the computer... and so far everything's been going through."

But Jeanne Finberg, supervising attorney for the National Senior Citizens Law Center, says Hewitt is one of the lucky ones — she was able to find help. "But for every person that does that or knows who to call, there's another 10, or maybe 100, we don't know, who are just going home without their medication. And those are the people I most worry about. They have mental illness, have Alzheimers, have physical conditions... and aren't getting their medication," she said.

Finberg says the next flood of problems is likely to come when the drug plans' "transition" policies expire. Currently, plans are supposed to give patients 30 or 90 days worth of whatever medicines they were taking, even if the plan wouldn't normally cover that drug.

That's supposed to give patients time to get things straightened out — to get to their doctor to see if they can switch to a drug that is covered, for example, or to file an appeal. Finberg says pharmacists are supposed to notify patients that they need to act, "but we're finding that's not happening; that they're not giving them a piece of paper notice, and it's not posted either."

And if patients don't know to act, she says, they'll find themselves in trouble when they go to get that prescription refilled.

State officials are also reporting that while things are improving, they're not out of the woods yet. Jude Walsh, special assistant to the governor of Maine, says the state is still paying for prescriptions for low-income residents whose costs should be covered by their Medicare plans. The costs, however, are far less. In January, "we were paying $50,000 to $100,000 a day," she said, "and I think now it's getting more manageable; it's running about $10,000 a day

The federal government has pledged to pay the states back. But Health and Human Services Secretary Michael Leavitt wouldn't say exactly when the problems would be fully resolved.

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