WASHINGTON—Many of Medicare's poorest and most sickly patients are going without their medications because of administrative glitches, misinformation and confusion surrounding the new Medicare prescription drug benefit.
Experts had warned that many of the 6.4 million low-income people who get benefits from Medicare and Medicaid could miss out on their life-sustaining medicines when their drug coverage shifted on Jan. 1 from Medicaid to private plans sponsored by Medicare. In interviews, advocates for the elderly as well as lawmakers and seniors themselves indicated that that's happening.
Some, such as Deborah King of New York, were placed automatically in new drug plans that don't cover their medications. Others were getting stuck with extra out-of-pocket fees because their new enrollment status couldn't be verified.
Medicare's contingency plan for patients who aren't enrolled in drug plans also is proving problematic. The agency wants pharmacists to give these customers short-term refills at no cost and bill Medicare later. But some pharmacists don't know about the agreement, and others are balking because they fear they won't be reimbursed.
"There's almost nothing that isn't going wrong," said Jeanne Finberg, an attorney for the National Senior Citizens Law Center in Oakland, Calif. "People are crying. They're calling their legislator's office in tears."
These problems and jammed phone lines that prevent pharmacists from confirming customers' plan enrollments mean that many patients can't get their medicine.
While the extent of the problem is unclear, health experts say the situation is dangerous because those patients who get Medicare and Medicaid benefits have higher rates of chronic illness, disability, cognitive impairments and other health needs. Their lives and livelihoods depend on their medicine.
Concerns about their welfare have prompted New Hampshire, Maine and the city of Baltimore to agree to pay the prescription costs for these people, who are called "dual eligibles," if problems arise. On Friday, New Hampshire Gov. John Lynch invoked his emergency powers and issued an executive order directing the state to pay claims when the Medicare system breaks down.
Lynch said the new drug benefit "has been a nightmare for many of our citizens."
"The problems are so overwhelming for our pharmacists and our citizens that New Hampshire's original back-up plans are not sufficient," Lynch said in a statement. "It is clear to me, to the Republican and Democratic leaders in the legislature, that we need to take additional steps to protect our citizens."
King, a 38-year-old disabled mother of two, said she's gone four days without her six prescription drugs for sickle cell anemia, ulcers, blood clots and other problems. King, who used to get prescription drug coverage by Medicaid, was automatically enrolled in a Medicare drug plan when she didn't choose one on her own.
But officials never told her of the change, she said. King only found out last weekend when her pharmacist told her that her new plan doesn't cover any of her medications. Her body weakens more each day that passes without her medicine.
"What am I to do now? That's what I've been asking for four days," King said. "I can't even get up off my bed I feel so bad. I can't even cook dinner for my kids I feel so bad. My kids are worried because they see me sick like this and they're like, `Do you have to go to the hospital?' They can't take this. I've been in the hospital all my life. And they do this to me so I have to go back into the hospital? This is not fair."
Earlier this week, Medicare's senior policy adviser Larry Kocot urged Medicare/Medicaid enrollees like King to contact their regional Medicare office when similar problems arise. Kocot said "bumps in the road" are inevitable, but he appealed for patience and added that he was "very, very pleased" with implementation of the new benefit so far.
"This is going to take some time," Kocot said. "And all we're asking is that people give us just a few days to get this thing up and running in the way that we want to see it run."
Some of the problems stem from a surge in the Medicare drug program enrollment in late December, Kocot said. Because drug plan enrollment letters usually take five days to process and benefit cards can take three to five weeks, many people who signed up in late December haven't received their proper enrollment materials yet.
Medicare has urged plan managers to expand their consumer and technical support help lines and to reduce wait times for pharmacies trying to confirm patient plan enrollment, Kocot said.
Fadi Atiya, a pharmacist and owner of Galloway Pharmacy in San Diego, said more than half his customers receive both Medicare and Medicaid benefits. Unable to verify enrollment for most customers because of backups in drug plan and Medicare phone lines, Atiya has passed out between $20,000 and $40,000 worth of medicine since Jan. 1 without compensation. He said he had no choice.
"I've owned this place for 11 years. I've watched these patients recover from heart attacks, kidney transplants. They're like family to me," Atiya said.
He's hoping he'll be reimbursed, but he isn't sure. He also wonders why the new program wasn't phased in in a few states at a time so that glitches could be worked out.
"The whole implementation has been horrific at best," Atiya said.
(c) 2006, Knight Ridder/Tribune Information Services.
PHOTO (from KRT Photo Service, 202-383-6099): MEDICARE
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