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, while many patients are still experiencing problems getting their medicines.
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Medicare Drug Benefit: A Two-Month Report Card

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Medicare Drug Benefit: A Two-Month Report Card

Medicare Drug Benefit: A Two-Month Report Card

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STEVE INSKEEP, host:

This is MORNING EDITION from NPR News. I'm Steve Inskeep.

RENEE MONTAGNE, host:

And I'm Renee Montagne.

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.

Representative JIM MORAN (Democrat, Virginia): 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.

INSKEEP: Republicans disagree, including President Bush, who praised the plan in his weekly radio address on Saturday.

President GEORGE W. BUSH: More than 25 million people with Medicare now have prescription drug coverage, and hundreds of thousands more are enrolling each week. This new coverage is saving seniors money on their drug premiums. The typical senior spending about half of what they used to spend on prescription drugs each year.

INSKEEP: So those are the competing political claims. To find out what's really happening, we asked NPR's Julie Rovner to re-visit some of the people she's interviewed; people dealing with the drug plans on the ground, to see what they think.

Here's her report.

JULIE ROVNER reporting:

Sue Wolf Nelson is director of the Family Healthcare Pharmacy in Fargo, North Dakota. 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.

Ms. SUE WOLF NELSON (Director, Family Healthcare Pharmacy): For instance, their co-pay may have been wrong initially, then corrected, and now we're back to wrong again. So we're having to re-address all the same things, which is a little frustrating to face again.

ROVNER: Some people whose problems were straightened out are doing okay. Among them is Washington, D.C. resident Pearle Hewitt, who takes medications for a variety of illnesses, including cancer.

The first time she tried to use her new plan, Hewitt was charged far more than she was supposed to pay and more than she could afford. Staffers from the District's Health Insurance Counseling Program stepped in, and now Hewitt reports she's doing fine.

Ms. PEARL HEWITT (Washington, D.C.): What I do is give them my prescription and show my card, the little card they gave me. And evidently they must got me in the computer. They got me in the computer and so far everything's been going through.

ROVNER: But Pearle Hewitt is one of the lucky ones, says Jeanne Finberg. She's supervising attorney for the National Senior Citizens Law Center. Hewitt got herself to someone who could help.

Ms. JEANNE FINBERG (Attorney, National Senior Citizens Law Center): But for every person that does that, or knows who to call, there's another ten or maybe a hundred, we don't know, who are just going home without their medication. And those are the people I most worry about. There are people that have mental illness, have Alzheimer's, who have physical conditions, and aren't getting their medication.

ROVNER: Finberg says the next flood of problems is likely to come when the drug plan's 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.

Ms. FINBERG: But we're finding that that's not happening, that they're not giving them a piece of paper notice, and it's not posted either.

ROVNER: And if patients don't know to act, 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, although the costs are far less.

Ms. JUDE WALSH (Specialist Assistant to the Governor, Maine): We were paying, you know, anywhere from $50 thousand to $100 thousand a day, and I think now its getting more manageable, it's running about $10 thousand dollars a day.

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

Julie Rovner, NPR News, Washington.

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