The States Step In As Medicare Falters

Pharmacist Rich Harvie fills a prescription in Montpelier, Vt. Medicare's drug program has been beset by problems.
Pharmacist Rich Harvie fills a prescription in Montpelier, Vt. Medicare's drug program has been beset by problems. (By Toby Talbot -- Associated Press)
By Ceci Connolly
Washington Post Staff Writer
Saturday, January 14, 2006

Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving medicines.

Computer glitches, overloaded telephone lines and poorly trained pharmacists are being blamed for mix-ups that have resulted in the worst of unintended consequences: As many as 6.4 million low-income seniors, who until Dec. 31 received their medications free, suddenly find themselves navigating an insurance maze of large deductibles, co-payments and outright denial of coverage.

Yesterday, Ohio and Wisconsin announced that they will cover the drug costs of low-income seniors who would otherwise go without, joining every state in New England as well as California, Illinois, Pennsylvania, Arkansas, New Jersey, North Dakota, South Dakota and New Jersey.

"This new prescription drug plan was supposed to be a voluntary program to help people who didn't have coverage," said Jeanne Finberg, a lawyer for the National Senior Citizens Law Center. "All this is doing is harming the people who had coverage -- America's most vulnerable citizens."

Hailed as President Bush's signature domestic achievement, the program, which began Jan. 1, offers drug coverage for the first time to 43 million elderly and disabled Americans eligible for Medicare. At the same time, 6.4 million low-income beneficiaries who were receiving their medications through state Medicaid plans were switched into Medicare for their drug benefits and told they would not be charged the standard $250 deductible or co-payments.

But interviews with two dozen people -- state officials, pharmacists, advocates for seniors, and Medicare clients -- revealed a host of problems. Many poor seniors were never enrolled or were enrolled in plans that do not cover their medications. Others received multiple insurance cards, creating confusion at the pharmacies. Some were charged the deductible and unaffordable co-payments. And some, such as Laurine League, left empty-handed.

"For years I've had no problems, going to the same pharmacy," said League, 49, a Queens, N.Y., woman with severe mental illness. "The pharmacist told me one drug was going to cost $198. I don't have that kind of money."

The states that have stepped in to help have already incurred several million dollars in unexpected drug bills, but Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services (CMS), said he did not have the authority to reimburse them. He urged states, pharmacists and providers to work with his agency to collect reimbursements from insurance companies administering the prescription program.

Acknowledging that some of the 6.4 million low-income beneficiaries known as "dual-eligibles" have been overcharged or denied medication, McClellan said: "That is simply not acceptable. We have been working around the clock and around the country to make sure those beneficiaries get the prescriptions they need."

California Gov. Arnold Schwarzenegger (R), announcing his intention to spend as much as $70 million to provide two weeks' worth of medicine, said he expects a reimbursement. "While I am confident the federal government will resolve the problems with this transition, these people need our help now," he said, "and we're going to be there for them."

Politicians in both parties were quick to rise to the defense of a particularly vulnerable population. As a group, dual-eligibles have incomes below the poverty rate of $9,570 a year and take an average of 15 medications a day. More than half are women, 40 percent have cognitive impairments such as Alzheimer's and 20 percent do not speak English, according to Finberg.

"The dual-eligibles should have been the last group enrolled because they are the hardest to get going," said Thanh Lu, who focuses on Medicare issues at the Progress Center for Independent Living in Illinois. Clients who are in nursing homes, who have schizophrenia, or who are deaf or blind are ill equipped to tackle the complex new system. Medicare compounded the problem by sending out a handbook that incorrectly told low-income seniors they could enroll in any plan at virtually no cost, he said.

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