Ariz. pays for Medicare mess - East Valley Tribune: News

Ariz. pays for Medicare mess

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Posted: Saturday, January 14, 2006 5:03 am | Updated: 2:08 pm, Fri Oct 7, 2011.

Faced with rising numbers of poor, disabled, elderly Arizonans struggling to get their prescriptions filled, Gov. Janet Napolitano late Friday joined 14 other governors in taking emergency action to plug some of the holes in Medicare’s new drug plan.

Napolitano’s executive order frees up $500,000 for one month to cover a portion of the 97,000 people who are eligible for both Medicare and the Arizona Health Care Cost Containment System — transplant recipients, those with life-threatening conditions and people who have not yet been assigned to a drug plan.

"These people are among Arizona’s most vulnerable citizens," Napolitano said. "The prospect that they would not be able to receive the medi- cations they need because of the failure of the federal government made it necessary for the state to step in."

The money, from the state’s health crisis fund, is expected to cover people who may be overcharged or overlooked in the next month, said Anne Winter, the governor’s policy adviser for health and human services. If the numbers continue to grow and the federal Centers for Medicare and Medicaid Services hasn’t yet straightened out the problem, she said more funds may be needed.

"We’re just going to start paying for those medications. We just have to," Winter said.

Because of confusion over which part of Medicare should cover their drugs, transplant patients were being denied lifesaving antirejection medication since the drug plan was launched Jan. 1. Dialysis patients on AHCCCS also were being denied.

"The pharmacists were getting denials" from Medicare, said Charlie Thomas, transplant social worker at Banner Good Samaritan Medical Center in Phoenix. "We expect we’ll continue to hear from people over the next few weeks when they go in to get their medications."

AHCCCS contacted drug plans to clarify that the medications should be covered, the Arizona Kidney Foundation has paid for some medications out of its charity fund, and the new state funding should cover any additional patients who come along.

While Thomas said transplant recipients are warned never to go off their medication, disability lawyer Peri Jude Radecic is concerned that others will go without.

"How many people have been turned away at a pharmacy and not made a call?" said Radecic, with the Arizona Center for Disability Law. "It’s important that people know they can call and get this situation resolved and not go without their medications."

Other states are spending millions of dollars a day to provide prescription drugs to the poor — California expects to pay $70 million over 15 days — and like Arizona hope to eventually be reimbursed by the federal government. The Bush administration, however, has said states must first try to collect from the private insurance plans.

Meanwhile, federal health officials are working with states and health plans to straighten out computer and data entry glitches that earlier this week left nearly 20,000 Arizonans without drug coverage and others waiting for hours in pharmacy lines only to be overcharged for deductibles and copays.

From California to Massachusetts, the widely touted prescription drug plan has wreaked havoc with the 6.4 million so-called dual eligibles, those who can least afford their medications and tend to need more of them. They were to have been automatically enrolled last fall in private drug plans that contract with Medicare. Backup plans allow pharmacists to enroll them on the spot with proper ID or offer a 30-day supply of medication.

In response to the widespread criticism and emergency orders by governors, the communications director for the Centers for Medicare and Medicaid Services issued a statement this week that laid much of the blame on the beneficiaries.

"The significant majority of individuals who are having payment issues at the pharmacy counter are people who are dual eligibles . . . who were first automatically assigned to one health plan but chose to re-enroll in a different plan," Jack Cheevers wrote.

But that wasn’t the main problem in Arizona. A computer glitch caused the federal system to reject those enrolled in four of the health plans, and AHCCCS officials said they were unaware of it until after the plan took effect.

AHCCCS deputy director Tom Betlach said that problem has been resolved, and what remains are scattered cases of people being charged deductibles or expensive copays. For the first time, people on AHCCCS must pay copays of $1 to $5 a piece, but some are being charged much more. In addition, inaccurate or incomplete information is being sent from the federal system to private health plans, causing some people to be denied their prescriptions.

"They clearly understand that that is a problem and they are working on their system," Betlach said. During a conference call with Medicaid directors in other states, he said, federal officials promised to deliver new data Sunday.

Betlach said the governor’s executive order will cover about 3,600 people.

"There are still going to be implementation issues," he said. "This is not a cure-all."

Rep. Linda Lopez, D-Tucson, has introduced a bill to cover the copays for AHCCCS members on Medicare. Radecic said AHCCCS estimates it would cost about $7 million, and she hopes Napolitano includes it in her budget proposal, to be released next week.

Learn more

Information: For information about Medicare drug coverage, call the State Health Insurance Assistance Program, (800) 432-4040 or (602) 542-6595. Or call the Area Agency on Aging at (602) 264-2255.

• Those enrolled in both Medicare and the Arizona Health Care Cost Containment System should call AHCCCS at (602) 417-7100 or (800) 962-6690.

• Call your pharmacy several days before you need a prescription refill to confirm your drug coverage.

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