District To Plug Medicare Drug Gap

City Joins States Covering Those Missed by Plan

The Legal Aid Society's Sarah Lichtman Spector, left, helped Fredrica F. Gonzales when her pharmacist could not find her in a Medicare database. (Photos By Jahi Chikwendiu -- The Washington Post)

The District will temporarily pay for medicines for thousands of elderly and disabled residents caught in the mess of computer troubles and bureaucratic breakdowns that have marked the new Medicare drug program's start, Mayor Anthony A. Williams said yesterday.

Neither Virginia nor Maryland has taken such action, though nearly two dozen states across the country have decided to cover the prescriptions of low-income beneficiaries as a public health emergency. Many people were being refused critical medications or were being charged as much as 80 times their usual co-payment.

All of these "dual eligibles" -- medically and economically vulnerable people who receive Medicare and Medicaid -- should have been shifted automatically Jan. 1 from local Medicaid drug provisions. But because of myriad problems with the new, incompletely tested system, some were never enrolled in new insurance plans, and others were put in plans that do not include their prescriptions.

Federal health officials pledged Tuesday to intensify efforts to remedy Medicare Part D, as the drug benefit is known. However, they did not say whether they would reimburse states or local jurisdictions that step in with stop-gap measures, as Williams urged yesterday.

The mayor's directive sets aside as much as $3 million from the city's contingency cash reserve to assist these individuals. Over the next three months, their biggest bill should be their usual $1 or $3 co-payment, according to his announcement.

"I'm hoping that the federal government will move quickly to smooth out the flaws in this new program so that no American is denied basic health care," Williams (D) said.

Virginia officials have not ruled out following suit. Gov. Timothy M. Kaine (D) was briefed about problems there but wants to wait on a decision until he can gauge the effect of recent Bush administration directives to fix the program. Despite several health care advocates describing clinics from Arlington to Abingdon as inundated with calls, administration officials said they believed the number of complaints was lower than in other states.

In Maryland, where lawmakers are contemplating no action, Baltimore is filling the breach with support and dollars. In 18 days, its "Surveillance and Response Initiative" has received dozens of reports of difficulties from local pharmacies and has paid more than $2,000 on 10 individuals' prescriptions.

"It's showing no signs of letting up," city Health Commissioner Joshua M. Sharfstein said yesterday. "We're moving past some problems and finding others."

Sharfstein himself talked to one woman as she stood, crying, at her pharmacy counter. "I need my medicine. I'm afraid to go home," the woman said. The commissioner told her to put the pharmacist on the line. "I said, 'We're going to pay for it.' "

Yet the volume of calls in Baltimore is but a fraction of the concern in the District. Nearly 10 percent of the 16,000 D.C. residents who qualify for Medicare and Medicaid have called local help-lines in worry or panic this month. Many remain without coverage.

At the Health Insurance Counseling Project, part of George Washington University's National Law Center, director Suzanne Jackson arrived one morning last week to find 200 voice-mail messages. There usually are 150 calls a month. "This is the crisis of the day, " she said.

Among the messages waiting yesterday: A woman trying to help her mother, who speaks no English. A gravely-voiced senior who said she had lost her ID card. A man calling in reference to "the medical situation" who left out several digits of his phone number. Another woman who immediately became a priority because she mentioned "it's about my medications."

Jackson and her staff have handled cases in which cardiac prescriptions were denied. One pending situation involves a widow who is recuperating from spinal surgery and has two metal plates in her back. Because Medicare did not enroll her in a new plan, she has been unable to get pain pills.

"These cases take hours" to resolve, Jackson said.

The project joined with the Legal Aid Society of the District of Columbia and Health Assistance Partnership, Families USA, in writing the mayor a detailed, impassioned letter requesting his emergency action. "This doesn't make any sense, from a public health perspective, having people go to the ER," said Eric Angel, legal director of the law group.

One of the organization's recent triumphs came after a week of pressure by staff attorney Sarah Lichtman Spector. Client Fredrica F. Gonzales called when her longtime pharmacist could not find her in any Part D database. By the time Spector helped solve that mystery -- the District native, it turns out, had been assigned to a plan -- Gonzales was out of several prescriptions. The new system wanted to charge her standard deductibles to refill them.

"I was hyper, angry and anxious," she said. The total exceeded $80 for just three of her seven medicines. Gonzales, who has bipolar disorder, high blood pressure and asthma, lives on $627 a month.

Staff writers Chris L. Jenkins and Mary Otto contributed to this report.