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Confusion Persists as Medicare 'Part D' Program Begins

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Confusion Persists as Medicare 'Part D' Program Begins

Health Care

Confusion Persists as Medicare 'Part D' Program Begins

Confusion Persists as Medicare 'Part D' Program Begins

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  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
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People who signed up for the Medicare Part D program are now limited to specific drugs included in their plans. Those who remain confused by the program do have options to dispute the new limit.


Some scheduled yet fundamental changes have been made to the Medicare Prescription Drug Program. As of yesterday, insurers only have to cover drugs on a limited list. Medicare critics say for patients, the transition from being able to get most drugs to being able to get only certain ones is likely to be difficult. Medicare officials say they're ready.

NPR's Joanne Silberner has more.


Eighty-two-year-old Eva Smothers(ph) leaves midway between Memphis and Nashville. She's got a Medicare Drug Insurance Plan and she's got a difficult-to-treat lung infection. On Friday, she received a letter from her insurer about a prescription for one of her three antibiotics. It was covered in the transition period that ended yesterday.

Ms. EVA SMOTHERS (Medicare Plan Participant): Before I can get this refilled, the provider has to fill out a blank form and send it back in to the drug company and I have eight tablets left.

SILBERNER: It's not part of the limited list covered by her plan. Smothers is worried because her husband, who has Parkinson's disease, got a letter about a different drug several weeks ago. Their doctor's assistant immediately got the form filled out.

Ms. SMOTHERS: She had sent it back and then they had sent it back to her for something and she had sent it back again. And we still don't have it approved or disapproved.

SILBERNER: Critics of the Medicare plan say Smothers and her husband are not alone. Robert Hayes is the executive director of the Medicare Rights Center.

Mr. ROBERT HAYES (Executive Director, Medicare Rights Center): Lots of people are going to face the difficulty of not being able to get the drugs they need, the drugs their doctors are prescribing.

SILBERNER: But the head of Medicare, Mark McClellan, doesn't expect the transition period to be difficult. Companies are required to cover several drugs in every class. He says millions of people whose drugs weren't on their company's list already have switched. He says those who haven't still have options.

Mr. MARK McCLELLAN (Chief, Medicare): Beneficiaries who did not transition to a covered drug by the end of the transition period can contact their plan. That's one way to make sure they understand the transition process and their rights.

SILBERNER: And he says Medicare will hold the plans to strict time limits on appeals. Eva Smothers' pharmacist, Tim Tucker, is impressed with Medicare's efforts, but speaking from the floor of his busy community pharmacy in Huntington, Tennessee, he says he's not so confident in the various drug insurance plans.

Mr. TIM TUCKER (Pharmacist, Huntington, Tennessee): I fault the plans. The plans were not ready on January the 1st and they're still having a lot of issues as we stumble through these different challenges that we face. And transition is just the next challenge that I see us facing.

SILBERNER: In the last couple of months, only a few of the plans told him when he was filling a prescription that won't be covered next time, making it difficult for him to warn his customers. As the details get worked out, Tucker says the key is patience.

Mr. TUCKER: The pharmacists and the healthcare providers, the physicians, the nurse practitioners and physician's assistants are going to work really, really hard to try and get the patients' medicines adjusted appropriately, but it may not happen in the next five minutes like our patients would like for it to happen.

SILBERNER: One other change has just gone into effect: plans can now change the drugs they cover, so long as they get permission from Medicare and give their customers 60-days' warning.

Joanne Silberner, NPR News, Washington.

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