I live 50 miles away from my mom, who's 82. Because of the distance, it's not easy for me to drive her to the store or to doctor's appointments, like my sisters do.

So I offered to help pick out her Medicare drug discount card -- which, unless you've been living inside a sealed barrel in a Canadian drug warehouse for the past several weeks, you know the federal government has just introduced as its first step in making prescription drugs more affordable for Medicare recipients. Seniors can begin using the cards as early as June if they sign up for one this month.

Mom doesn't have Internet access, and since she has hearing problems, getting long, detailed information over the phone can be tough for her. And hey, I've been a health care reporter for more than a decade, conducting much of my research on the Internet. Picking the prescription card that would help my mom the most should be easy for me, right?

I figured the effort would take me an hour or so. Instead, I spent nine hours trying to track down accurate information on the phone and on the Web. The upshot? I'm not much closer to knowing which is the best card for her than when I started. I have, however, learned the following important lessons:

* Just because the Medicare.gov Web site says a drug isn't covered under a specific discount-card plan doesn't mean it really isn't.

* Just because Medicare.gov says a drug is covered doesn't mean it necessarily is.

* The prices Medicare.gov cites for medications under a given discount plan don't necessarily correspond to the prices the plan gives out over the phone.

* The prices that a card's sponsors give out over the phone can differ, depending on whom you talk with.

* Whether Medicare.gov says a pharmacy participates in a given plan doesn't seem to bear any relation to the info the plans, or even the pharmacies themselves, have.

* Calling 800-MEDICARE isn't much help. I tried the number seven times on a single day last week, starting at 9:40 a.m. and finishing at 11:20 p.m. I never got through to a human.

I started out well prepared. Mom made me a list of the nine drugs she has to pay for out-of-pocket for her fairly common conditions:

For asthma/chronic obstructive pulmonary disease (COPD): an albuterol inhaler, Serevent Diskus and prednisone (5 mg).

For allergies: Allegra (180 mg)

For apparent glaucoma: Isopto Carbachol eyedrops (3 percent) and methazolamide (50 mg.)

For sleep problems: Ambien (5 mg)

For congestive heart failure: Lanoxin (0.125 mg)

For water retention: hydrochlorothiazide (12.5 mg)

Mom told me she typically pays $453.96 per month for these medications, after her 10 percent senior citizen discount at the local pharmacy. She told me her monthly income and the amount in her savings account, so I could check whether she'd qualify for the $600 credit available to low-income seniors. I was set.


At 9:45 a.m. last Monday, I first called 800-MEDICARE. (Very) long story short: The automated voice system tells me there is an unusually high volume of calls and to try again later. Suggested times: before 6 a.m. (!) or after 6 p.m. Then I'm disconnected. I would try six more times that day -- the last call at close to midnight -- with no better luck.

Go to www.Medicare.gov

Fine. I'll just go to the Web site. At Medicare.gov, the first thing I see is, "Find available Medicare-approved drug discount cards, and compare prices for your prescriptions." Perfect.

I click through and answer eight quick questions about Mom's income, assets, etc. Then I continue on to the next page, where I'm asked to select the drugs Mom needs.

Six of Nine Drugs Aren't Listed!

Ambien, hydrochlorothiazide and methazolamide are missing from the Medicare list. How strange.

Maybe they're listed under different names? I don't see any help on the Medicare site for this, so I jump over to www.drugstore.com, where I'm able to quickly find all nine drugs. (I'm definitely spelling them right. I do this for a living.) I find possible names that the drugs might be listed under. Then back to Medicare.gov.

But no, the drugs aren't listed under these other names, either. I try calling 800-MEDICARE again, thinking maybe someone can help me. It's still tied up.

Okay, fine. If Mom can get discounts on even six of the nine drugs, that's some help, right? I click "continue" on the Medicare site.

The next page tells me Mom's not eligible for the $600 assistance. Fine. The page also lists 40 plans that are available in Mom's Zip code. I click the "Compare Prices" button.

Arrrrggghhh! For another three of the drugs -- Serevent, Lanoxin and albuterol -- I get a message saying, "Your selected drug was not found." Oh, come on. I'm not that familiar with Serevent and Lanoxin, but just about every asthmatic I know uses albuterol. How can this drug not be available?

I return to drugstore.com in search of other names these drugs might be listed under. I try all possibilities at Medicare.gov. Nada.

Now it appears that the best card will provide discounts on only three of the nine drugs Mom needs. These account for only $150.44 out of the $453.96 she's currently spending. This is looking less promising all the time.

For the remaining three drugs, I'm supposed to enter her dosages and how many she needs each month. No problem for prednisone or Allegra. But when I get to Isopto Carbachol, I'm stumped. For these eyedrops, Mom gets one bottle at a time, and uses four drops per day. The amount the system automatically suggests is "30 per month (e.g., 30 tablets, 1 bottle, 1 inhaler, etc)." Hmmm. I change the "30" to "1" and hit "Continue."

The system tells me there are 15 programs that provide the three drugs and have participating pharmacies with five miles of her house. I click through to a few, but quickly see that Isopto Carbachol is listed as costing between $4 and $5. Odd. She usually pays $44.99. "1" must have been the wrong dosage to select.

I try again to call for some help on this dosage question. Can't get through. I go back and pick "30." (I assume at first that it must refer to 30 days' supply. I later see that drugstore.com sells these drops in 30 ml bottles, so maybe that's the meaning of the "30" on the Medicare site. Hmmmm. But the next day I find out my mom's bottle is only 15 ml {ndash} so there's a good chance the price quotes I got are for twice as much as she usually uses in a month. Grrr.

It Looks Too Good to Be True

For 30 days (ml?) of Isopto Carbachol 3 percent solution, all the plan prices run about $73 to $75 -- except for The Pharmacy SmartCard, which only charges $17.10. Wow! Now that's a deal. In fact, the Pharmacy SmartCard offers the best prices for the three drugs combined, $95.07, compared with other 14 cards, whose quotes run from $139.25 to $176.62 per month. But a closer look shows that the big price difference on the eyedrops accounts for all the big savings. Pharmacy SmartCard is actually a little pricier on the two other drugs. The annual enrollment fees range from free to $30.

All plans are also list as a participant the Calvert Arundel Pharmacy in Owings, Md., the store my mom has told me she wants to continue using. Perfect.

Pharmacy SmartCard definitely looks like the best deal. But something keeps nagging at me: The price for those eyedrops just sounds too good to be true.

So I find SmartCard's phone number on the Medicare Web site and call. A nice customer service rep answers promptly and looks up the pricing: $26, or $18 for generic.

"But Medicare.gov says your price is $17.10 for brand name."

She doesn't know why that is, but assures me the price is $26. And hey, that's still far better than the other company's prices.

After I get off the phone, it occurs to me: If the price was wrong on the eyedrops, is it wrong on the other stuff?

I call back SmartCard, saying I want prices on all of my mom's drugs and can't find all of them on the Medicare Web site. The customer service rep says I'd better talk to a pharmacist, who may know if the drugs are listed under different names. And guess what -- SmartCard has Medicare discount card prices for all nine drugs. The total comes to $414.47, a savings of around $40 a month, or almost 10 percent better than Mom's doing with Calvert Arundel's senior citizen discount.

But wait a minute. The pharmacist has quoted me $52.53 for the Isopto Carbachol -- the same drug the customer service rep said was $26 (and the Medicare Web site said was $17.10). What gives?

Well, the pharmacist explains, the customer service rep probably looked up the drops under "Isopto" instead of "Iso." But they are called "Isopto," I point out. Yes, that's true, she explains, but their computer system has a glitch in it that the customer service rep probably isn't aware of: You have to enter the drops as "Iso." If you enter them as "Isopto," you get pricing that hasn't been updated since 1997.

Great. If the info on the SmartCard is so messed up, what about the others? It's time to hit the phones.

Secret Prices!

The Medicare Web site listed "Precision Discounts (Option A)" as having the second best price -- $139.25 -- for my mom's three listed drugs (Isopto Carbachol, Allegra and prednisone). I call Precision to confirm.

The customer service rep tells me that they don't cover prednisone, but they do cover hydrochlorothiazide, Lanoxin (although only in double the dose my mom takes), methazolamide (for $54 to $67, more than the $52.99 she pays with her senior citizen discount and Serevent ($10, instead of Calvert Arundel's $99.54).

And she can only give me the price for Isopto Carbachol in pill form. "Um, these are drops that go in her eyes," I tell her. "Don't you think using pills would be painful?" She is not amused.

Worse, she tells me that my mom's pharmacy doesn't participate in the plan. "But the Medicare Web site says they do!" Sorry, Calvert Arundel is not in the Precision database.

I hang up and call back, getting a different rep.

"Is it true that Calvert Arundel Pharmacy isn't in the plan?" Yup.

"Is it also true that she can get Serevent for $10 if she uses one of the participating pharmacies?"

Well, the rep can't tell. . . . It seems that the database at Precision Discounts has its own little glitch: It can price only pills. Any liquids or inhalers come up with inaccurate information. (Okay, that may explain why the first rep had pill prices for the eyedrops.) But, she helpfully tells me, she can give me another phone number where someone can look up the Serevent price for me.

I call the other number and am put on hold. Five minutes later, a rep says she can't tell me the price of the Serevent unless my mother has already signed up for Precision Discounts.

"No, I need to know the price so we can decide whether it's worth it for her to join Precision Discounts."

Sorry, she is not allowed to disclose the information -- but she'll be happy to transfer me to a number where they'll sign Mom up, and then they can transfer me back to her and she'll tell me the price. I don't think so, I tell her.

I call two more plans, Advantra X-tra and BD Advantage. Neither covers prednisone. Both do cover Lanoxin for $4 to $6, vs. the $22 to $24 offered by Precision and SmartCard.

Alas, BD Advantage says (contrary to the Medicare Web site) that Calvert Arundel Pharmacy doesn't participate.

Then I have a brainstorm. I'll call that pharmacy, find out which plans it participates in, and work backward from there. Reverse engineering!

Alas, this proves impossible. Leo Mallard, the pharmacy owner, tells me that even he isn't sure which plans he's participating in. That's because the pharmacy benefit managers (PBMs) he works with -- companies that administer prescription drug programs -- have been signing him up for Medicare drug discount programs without telling him. In fact, his staff is working right now to try to pull together a list.

Many programs won't give seniors significant savings over the 10 percent discount he already offers them, says Mallard. The plans he likes best so far are Community Care Rx and Pharmacy Care Alliance.

But according to Medicare.gov, his pharmacy doesn't participate in those.

Okay, Here's the Plan

We'll wait a few weeks. There's no deadline for enrolling and, as far as I can tell, the savings aren't going to be so great (if there are any at all) that deferring the decision could cost Mom much. And once she signs up for a card, she's stuck with it for a while: Changes aren't allowed until open season at the end of the year. So I'll give Mom's pharmacy time to sort out which programs it participates in and then get a list from Mallard.

In the meantime, maybe Medicare will clear up some of the Web site glitches. Maybe the discount card programs will work out their customer service and database issues and update some of those 1997 prices. Maybe the PBMs will let the pharmacies know which programs they are working with. Maybe Medicare will spring for a few more phone operators and cut back on the TV commercials. And maybe a squad of flying pigs with MBAs will descend into seniors' homes and help them make decisions personally.

I figure that, in a few months, helping Mom pick a discount card will be easy. It should take about an hour.


Lisa Barrett Mann, a regular contributor, has been following the Medicare prescription discount card program for the Health section.