Medicare Mess

[Guest guest]

What a mess!!!

Asclepios

Your Weekly Medicare Consumer Advocacy Update

Follow the Leaders

January 12, 2006 • Volume 6, Issue 2

With each passing day, it becomes more apparent that the problems that have

prevented people with Medicare from filling vital prescriptions under the

new Part D benefit are not going away any time soon. Poor people who relied

on Medicaid to cover their drugs up until December 31 cannot afford to buy

their medicines when some computer “glitch” blocks coverage by their new

privately run drug plan. Here are just some of the obstacles that people

with Medicare and Medicaid are running into:

They were not enrolled in a drug plan, and the pharmacist cannot or will not

take the time to electronically enroll them in a fallback plan.

They enrolled in a drug plan, but their billing information is not in the

system and the plan phone lines are overloaded. If the pharmacist does get

through, plan representatives are unwilling or unable to fix the problem.

They are enrolled in a drug plan, but their eligibility for lower copayments

of $1 to $3 is not recognized by the computer system. As a result, they are

charged full price until they pay a $250 deductible.

They are enrolled in a plan that does not cover all of their drugs. The plan

has not put in place a required system to allow a 30-day fill until an

appeal for coverage can be resolved or an alternative medicine prescribed.

As we near the end of week two of the new drug benefit, consumer advocates

continue to hear about such problems from people who are desperate to obtain

the medicines that keep them alive. Two days ago, over 700 pharmacists and

other health care providers were on a conference call with officials from

the Centers for Medicare & Medicaid Services (CMS) complaining about these

and other problems with the new benefit.

Incredibly, the response from CMS is to tout the millions of prescriptions

that are being filled.

Whatever some might hope, the problems that are preventing access to

life-saving medicines are systemic, not isolated incidents. The most

compelling evidence of that comes from the state of New Jersey, which last

Friday afternoon started to use its Medicaid program to fill the

prescriptions for people in that program who could not get their drugs

through a drug plan. In the three following days, the state spent $4.4

million on prescriptions. A conservative calculation, at $100 per

prescription, estimates the state filled at least 44,000 prescriptions. That

is 44,000 prescriptions for heart medicines, diabetes pills and other

life-saving drugs.

How many people among New Jersey's 145,000 dual eligibles (people with both

Medicare and Medicaid) would have walked out of the pharmacy without their

drugs if the state had not stepped in?

This public health crisis stems directly from the decision of Congress to

turn drug coverage over to for-profit insurers instead of running it through

the Medicare program. As a result, the administration of the benefit is

needlessly complicated and plans’ customer service and their provision of

adequate drug coverage are at the mercy of their profit margins. Congress

needs to reevaluate its decision as the problems with this private drug

benefit come to light. Lawmakers should also acknowledge the crisis created

by their abrupt termination of Medicaid drug coverage and immediately take

whatever steps are necessary to ensure that a safety net is in place.

Fortunately, governors in Maine, Massachusetts, Vermont, New Hampshire,

South Dakota, Rhode Island, Connecticut, and at least five other states are

all implementing plans that allow their Medicaid program to step into the

breach and temporarily cover drugs while these problems are addressed. It

costs money, but with enough states on board, CMS will be unable to resist

pressure to compensate states for providing this crucial assistance during

this public health emergency.

What is Governor Pataki doing to protect more than 500

000 dual eligibles in New York State?

What is Governor Jeb Bush doing to protect nearly 400,000 dual

eligibles in Florida?

What is your governor doing?

Click here to send a letter urging your state governor to use Medicaid as a

fallback source of drug coverage for people with Medicare and Medicaid.

Medical Record

“Hi. I’m returning a phone call. I’m waiting for someone to assist me. I’m

having a problem. I cannot get my drugs, my prescriptions. I cannot afford

them. I know I can get them if I pay for them, but I’m on low income and I’m

getting nowhere with this Medicare Part D. I applied December 1 through

SilverScript. It’s sitting somewhere in an enrollment program and going

nowhere. I have called Medicare again and again and again and they can’t

even find me on the screen. I am on the state’s computers as of December 17,

I believe, and I’ve made numerous phone calls. I am now going to call the

attorney general to see if somebody has to speed this up. I cannot even get

my medication. I need it for blood clots. I need if for high blood pressure

and I don’t want to go on and on about what I need it for. Obviously if I

could afford it, I would certainly be at the pharmacy and buy it. Unless I

can get these drugs within the next week, I don’t know what I’m going to do.

Neither does my pharmacy. Numerous phone calls have gone on deaf ears and no

one is doing anything about it” (Transcript of a phone message recorded on

the Medicare Rights Center hotline).

State governors intervened to provide emergency action for low-income people

with Medicare as the Medicare Prescription Drug Program is plagued with

implementation problems. Low-income people with Medicare around the country

were often overcharged, and some were turned away from pharmacies without

getting their medications, in the first week of the new privately run drug

benefit for people with Medicare. The problems have prompted emergency

action by some states to protect their citizens. Although there are no hard

numbers, concerns expressed by state officials and complaints from

pharmacists suggest a widespread pattern of problems (“States Intervene

After Drug Plan Hits Snags ,” The New York Times, January 8, 2006).

Senator Lautenberg, Democrat of New Jersey, announced his intention to

introduce a bill to repay states for the costs they are currently bearing as

a result of failures by the Bush administration to address coverage gaps

under the new drug benefit for people with Medicare. On Monday, January 9,

New Jersey was forced to spend $2.2 million for that day alone to cover the

costs of prescriptions of its residents with Medicare and Medicaid who were

wrongly denied coverage under a privately run Medicare drug plan. Since New

Jersey began covering these costs on Friday, January 6, the state has spent

a total of $4.4 million (“Lautenberg to Introduce Emergency Medicare

Legislation to Force Bush Admin. to Repay States for Covering Costs of

Prescriptions for Low-Income/Disabled Seniors ,” News from Lautenberg,

January 10, 2006).

Fast Relief: Medicare Part D Monitoring Project

The Medicare Rights Center (MRC) needs to hear about all the problems with

the Medicare Part D benefit, whether they happen to you or someone in your

community. With this information, we will be armed with the needed evidence

to push for a decent Medicare drug benefit.

Submit your story at www.medicarerights.org/partdstories.html.

*****

Help Us Eliminate the 24-Month Waiting Period for Medicare

Many people know that Medicare serves both older adults and people with

disabilities. Few are aware that Americans with disabilities must wait 24

months from their first Social Security disability income payment, which is

five months after Social Security deems them disabled, before their Medicare

coverage begins.

Medicare provides an invaluable safety net for Americans with disabilities,

providing good, affordable health coverage when the private insurance market

turns its back. Let us work together to make this health coverage available

as soon as people need it, rather than 24 months later. Help us eliminate

the 24-month Medicare waiting period.

The Medicare Rights Center is committed to eliminating the Medicare coverage

waiting period and we have recently embarked on a national media project to

do so. Our goal is to focus attention on the personal experiences of people

who

are currently in the 24-month Medicare waiting period; or

finally got Medicare coverage after having gone through the two-year wait.

These individuals would have to be comfortable talking to the press about

their health care experiences during the Medicare waiting period. If you

know of individuals with a compelling story who are willing to participate

in this project, please contact Heidi Kreamer at 800-333-4114, ext. 33 or

hkreamer@....

The Louder Our Voice, the Stronger Our Message

Asclepios—named for the Greek and Roman god of medicine who, acclaimed for

his healing abilities, was at one point the most worshipped god in Greece—is

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