RENEE MONTAGNE, host:
Medicare's new prescription drug benefit is off to a rocky start. Dozens of plans, overloaded computers and an entirely new system have left seniors scratching their heads. The problems are particularly serious for the six and a half million low-income Americans who get both Medicare and Medicaid and who lost their Medicaid drug coverage on December 31st. NPR's Julie Rovner has the story.
JULIE ROVNER reporting:
Pearl Hewitt(ph) is 71, a resident of Washington, DC, and takes a lot of medicine.
Ms. PEARL HEWITT: I've got about eight pills. I'm a Counsel patient. I have a heart condition and arthritis.
ROVNER: Hewitt had been getting her drugs through the Medicaid program at a dollar per prescription. She was well aware that coverage was going to end and she'd need to enroll in a Medicare drug plan by January 1st. With the help of her daughter and the Washington, DC, Health Insurance Counseling Program, she enrolled in a new drug plan, and she thought everything was good to go.
Ms. HEWITT: They sent me enrollment paper, a card and everything.
ROVNER: But when she went to pick up her first prescription, she got a nasty surprise.
Ms. HEWITT: Oh, they told me $250 deducible, $89 a month and $5 for each prescription, and I'm not going to be able to get no prescription till I came up with $250.
ROVNER: But that's the cost for those with higher incomes. Low-income people like Hewitt are supposed to pay no deductible, no premium and no more than $3 per prescription. It's a problem that's cropping up across the country. Low-income seniors are being correctly recognized by computers as enrolled in Medicare drug plans, but they're not flagged as low-income and are being charged the regular price. Stephanie Altman says that effectively cuts them off from their drugs. She's a staff attorney with Health and Disability Advocates in Chicago.
Ms. STEPHANIE ALTMAN (Attorney): People can't--you know, are walking out of their drugstores in tears and maybe don't have a credit card or someone to borrow from or the pharmacist won't put it on credit.
ROVNER: It's putting pharmacists in a difficult situation, says Tom Clark. He's with the American Society of Consultant Pharmacists.
Mr. TOM CLARK (American Society of Consultant Pharmacists): The pharmacy personnel are concerned that they may not get correctly reimbursed for the medication, and they may not be able to bill and get reimbursed later after the medication is dispensed.
ROVNER: That's what happened to more than 150 patients from the Peninsula Community Mental Health Center in Port Angelos, Washington. After case workers spent hours painstakingly matching each Medicaid patient to a drug plan, based on his or her specific medications, every pharmacy in town refused to provide the drugs at reduced prices, says center staffer Susan Flippan(ph).
Ms. SUSAN FLIPPAN (Peninsula Community Mental Health Center): In most instances, the pharmacists were online for hours, on hold, trying to get information from Medicare. They had no other resources available to them to contact other than Medicare itself. So they were turning patients away; in some cases, giving them two to three pills to get them by.
ROVNER: And going without drugs is perilous not just for those with heart disease or diabetes, but also for those with serious mental illness, she says.
Ms. FLIPPAN: Clients who were stable on medication, should they go even a few days without their medication, were at risk of hospitalization.
ROVNER: Pharmacist Tom Clark says overcharging low-income beneficiaries isn't the only problem with the new benefit. During this first month, plans aren't supposed to be enforcing rules that require special permission for certain drugs or making patients try cheaper medications first. But many plans are enforcing those rules, he says.
Mr. CLARK: There was one situation over the weekend where a nursing home had an outbreak of influenza and the Part D plan was imposing restrictions and not allowing the pharmacy to bill for influenza medications.
ROVNER: Medicare and Medicaid administrator Mark McClellan says that won't be allowed to continue, and he says that plenty of help is available, both from the plans themselves and from operators and case workers at Medicare's toll-free hot line.
Mr. MARK McCLELLAN (Medicare/Medicaid Administrator): We have lots of systems set up to work with states, to work with advocacy groups, to work with beneficiaries and their caregivers to help people connect with their coverage if they're having any difficulties.
ROVNER: In fact, says McClellan, the program is now filling more than a million prescriptions per day and problem reports are diminishing. But at least six states have started to use their own money to cover drug costs for low-income beneficiaries who are having problems and another three states are considering similar action. Julie Rovner, NPR News, Washington.
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