More than 500 Medicare beneficiaries whose prescription drug benefit was revoked by the District in recent months are receiving free medications again, health officials said yesterday. But they could not tell a D.C. Council meeting how long that will last -- or whether the city can afford to continue a plan that no other jurisdiction offers.
For the time being, Medicare beneficiaries in the D.C. Healthcare Alliance who are dependent on diabetes drugs, heart medications, pills for high blood pressure and other chronic care prescriptions will be entitled to free drugs through a new program funded by the city, officials said.
That might have been cause for cheer at the council's Committee on Human Services meeting yesterday, but patients were anything but happy. Several patients testified that last week, their prescriptions were still being rejected, highlighting the confusion that has surrounded the issue since it emerged last fall.
"I need my medicine," said Jesse Spells, 61, of Northeast Washington, who takes eight prescription drugs. "I have just enough to last until Wednesday. . . . I have to get my prescription filled so I can keep living."
Delores Carrington, 68, of Northwest, is an insulin-dependent diabetic with a heart condition. After a career as a cake decorator and a government worker, she said, she deserves a better fate than succumbing to diabetes or congestive heart failure because she can't afford several costly drugs a month.
"Without any insulin, I will go into a coma and die," she said. "I will die or be disabled and require round-the-clock treatment. . . . It's not right to attack us just because we're older and slower and sicker."
For 30 years, government pharmacists at D.C. General Hospital and city clinics dispensed free medications to any patient treated by doctors affiliated with those institutions. The generous rules never were formally enacted by law or regulation, city officials said, but it was a tradition no one dared to touch.
After the city privatized its indigent health care system and closed inpatient units at D.C. General two years ago, city officials knew they were going to have to end the tradition eventually because sharply rising pharmaceutical costs threatened to bust the budget.
Still, city officials avoided pulling the rug out from under the 510 Medicare beneficiaries until last summer, when a D.C. Health Department lawyer concluded that it was illegal for Medicare beneficiaries to participate in a health program designed for uninsured people. The benefit costs a total of about $800,000 a year.
An exasperated David McDonald, who cares for his 73-year-old aunt Josephine Steptoe, said she was cut off by the alliance because she has Medicare and earns too much for Medicaid, which provides unlimited drugs at virtually no cost. "Why is this happening?" McDonald asked. "What can she do? Somebody should stop the buck here."
The answer to McDonald's questions remained murky at the committee meeting because public and private officials were reluctant to take credit or blame for the policy change.
Tamara Smith, a senior executive with D.C. Chartered Health Plan, the private firm that administers the alliance, said that the 510 people were not dropped from the program. "It wasn't an active disenrollment," she said. "It was the phaseout of a benefit." But it was the only benefit that the 510 enrollees used.
Smith and Brenda Thompson Emanuel, chief of the Health Care Safety Net Administration, each tried to sidestep responsibility for the disenrollment order. D.C. Deputy Mayor Caroline N. Graham and D.C. Health Department Director James A. Buford were at a mayoral retreat.
Smith appealed to city officials to decide whether to pay for the drugs of low-income Medicare patients. "We believe a policy decision is necessary," she said.
To solve the problem temporarily, the city paid $260,000 to hire a Catholic archdiocesan group to administer a program to obtain free drugs from companies.
"We're trying not to leave the seniors in a total lurch while we try to find another solution," said Health Department attorney Philip Husband.