HHS Works to Fix Drug Plan Woes
Widespread Difficulties With New Medicare Benefit Reported

By Ceci Connolly
Washington Post Staff Writer
Wednesday, January 18, 2006

President Bush's top health advisers will fan out across the country this week to quell rising discontent with a new Medicare prescription drug benefit that has tens of thousands of elderly and disabled Americans, their pharmacists, and governors struggling to resolve myriad start-up problems.

Health and Human Services Secretary Mike Leavitt, who will visit Oregon and California, said yesterday that 24 million Medicare beneficiaries now have prescription coverage, compared with the 20.4 million who had been receiving drug benefits last year through state- or employer-sponsored plans. That means the new program, expected to cost $700 billion in the first 10 years, is providing drug coverage to 3.6 million new retirees.

In a call with reporters, Leavitt said enrollment in the program, called Medicare Part D, exceeded expectations and put the administration "well on track to meet our goal of enrolling 28 to 30 million in the first year." Last year, officials predicted 39 million seniors and disabled people would participate, according to documents published in the Federal Register on Jan. 28, 2005.

In the past month, 2.6 million people have signed up for a drug plan. Seniors have until May 15 to enroll.

Even as federal leaders touted the enrollment figures, state officials and health care experts continued to report widespread difficulties, especially for the poorest and sickest seniors who were forced to switch from state Medicaid programs to the new Medicare plans on Jan. 1. Nearly two dozen states have intervened, saying they will pay for medications for any low-income senior who is mistakenly rejected. The District, Maryland and Virginia have not intervened.

Saying "it is time for us to take care of our own," Republican Gov. Arnold Schwarzenegger said California will spend as much as $150 million to provide medications to as many as 1 million low-income seniors who have been turned away by pharmacists or overcharged co-payments because of glitches in computer databases.

"Right now, the new Medicare Part D prescription drug program is not working as intended," the governor said in a release.

In a letter to Bush, 14 Democratic governors wrote that, "while well-intended, the new Medicare drug benefit has caused confusion, mismanagement, and a bureaucratic nightmare."

Leavitt conceded that HHS caseworkers have responded to tens of thousands of complaints by seniors, pharmacists and others who could not get the correct medications at the correct price. But he promised to "fix every problem as quickly as possible."

To do that, HHS has hired thousands of customer service representatives and set up special phone lines for pharmacists. It also has notified insurers that if a drug is not going to be covered, the plans must provide a 30-day "transitional" supply until the patient's physician can recommend a comparable medicine that is covered.

"Since this is a new program, some people may experience a problem the first time they go to get their medicines, but we're confident that after you use it once, things are going to go more smoothly," he said. "If you are one of those seniors experiencing problems, our message is don't leave the pharmacy without your drugs."

Starting an enormous insurance program for 42 million people is bound to entail bumps, Leavitt said. "For the majority of people who are enrolled in the drug benefit, the system's working," he added. "Pharmacists across the country are filling more than 1 million prescriptions a day successfully. Seniors are continuing to enroll in large numbers."

Precise figures are not available, but government officials and researchers at health care think tanks said pharmacists were filling hundreds of thousands of prescriptions for previously eligible Medicare recipients before the Jan. 1 start of the new program.

"Many of the people already had coverage in 2005," said Tricia Neuman, who studies Medicare policy issues at the nonpartisan Kaiser Family Foundation. "The numbers show there's been some progress since December, but we clearly have a ways to go to reach everyone the program was designed to help." Medicare's actuaries reported that 8 million seniors would be eligible for subsidized drug coverage, based on income levels, and they projected 4.6 million would enroll in 2006. So far, 1.1 million are signed up, she said.

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