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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)

The first state to act was Maine, after its hotline recorded 18,000 calls on Jan. 3, said Jude Walsh, a special assistant to the governor.

"We had dialysis patients who were not getting medicines, pharmacies on hold for 60-plus minutes, some plans closed for the holiday," she said, describing some of the frantic calls. "One man called me -- he and his wife were on 15 medications. They had no co-payments on Medicaid. He went in for 15, and he left with one" medicine because of the cost, she said.

Yesterday the hotline uncovered a new problem, she said. Some beneficiaries have received letters from private health plans warning that the monthly premiums for their drug coverage will be deducted from their Social Security checks, even though they are poor enough to qualify for free coverage. So far, Maine has paid for 68,000 prescriptions at a cost of $3.6 million, Walsh said.

Some supporters of the Medicare expansion blamed pharmacists for not learning the new system. But many pharmacists said they attended classes and purchased new computer software in anticipation of the Jan. 1 launch.

"The first week was pure hell," said Mike Souders, owner of Metropolis Drugs in southern Illinois. Computer systems crashed, phone lines were jammed, and there was no way for him to confirm that patients were covered. He called in extra employees who worked the phones late at night, and he asked doctors to provide regular customers with drug samples until the confusion could be resolved.

"In 2000, for Y2K, we were practicing running systems for a year," he said, referring to computer preparations for the coming of the new millennium. "They started this up cold turkey."

Social workers and advocates have warned for months that moving the most vulnerable patients to a new program would require a slower, phased-in approach.

"All of the worst predictions came true," said Robert M. Hayes, president of the Medicare Rights Center. Many of the thousands of callers contacting the center said they were being told that the insurance plan they were assigned by the federal government does not cover their medications, he said.

If that occurs, pharmacists have been instructed to provide a one-month "transitional" supply until a doctor can prescribe a similar drug that is covered by the plan, McClellan said. In addition, CMS has devised a 14-step enrollment process for pharmacists, he said.

Baltimore Health Commissioner Joshua M. Sharfstein and his staff have personally been assisting pharmacies with that effort. "I don't think we have yet successfully counseled a pharmacist through that," he said.

"We've been doing enrollments and they have not taken less than an hour and a half" each, said MaryAnn Griffin, director of Alexandria's Office of Aging and Adult Services. She recently joined a CMS teleconference briefing but found that it was a "listen-only, completely scripted" event that did not address the myriad problems her staff is confronting.

From the outset, administration officials have said they would rely on states, doctors, family members and volunteers to help seniors negotiate the new system. But Anne Marie Murphy, Illinois's Medicaid director, said the CMS should be resolving the current problems.

"It's a little ironic that Congress and the administration are talking about cutting Medicaid administrative costs, and here we are rolling up our sleeves and doing all we can to make sure a federal program is working," she said.


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