Medicare director vows to fix woes - East Valley Tribune: News

Medicare director vows to fix woes

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Posted: Sunday, January 15, 2006 5:16 am | Updated: 3:13 pm, Fri Oct 7, 2011.

WASHINGTON - Tens of thousands of elderly poor people may have had trouble getting their medicine during the first two weeks of the government’s prescription drug benefit, and about 20 states have been forced to step in to help them, the top Medicare official acknowledges.

Arizona became one of those states Friday when G ov. Janet Napolitano issued an executive order to free 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.

The problems will be fixed, pledged Mark McClellan, administrator for the Centers for Medicare and Medicaid Services.

In some cases, people are not showing up in databases as being enrolled in a plan. When they do show up, many people are being told they need to pay hundreds of dollars before they can get their medicine. Instead, they should owe only nominal amounts.

‘’I’m working with the states, with the plans, with all of our partners to make sure people get the prescriptions they need,’’ McClellan said Friday.

Apache Junction resident Cyndie Mathers called the federal Medicare help line a few days before Christmas and was told her drug plan wasn’t listed. She was enrolled in a new plan, but last week her pharmacist said her antiseizure medications would cost hundreds of dollars. Mathers is on AHCCCS and permanently disabled with a brain injury.

"I was crying and very upset," Mathers said. "Why wasn’t the government prepared for this?"

Under the Medicare drug program, about 42 million disabled and older people are eligible to enroll in private plans that will subsidize their prescription drug costs. Millions of prescriptions have been filled without trouble, McClellan said, but there is growing concern that some of the poorest beneficiaries cannot get their medicine.

Some advocacy groups say they believe McClellan underestimated the problems.

‘’We could see the problems coming. We expressed concern, and it was just pooh-poohed. Now, our worst fears have been realized,’’ said Jeanne Finberg, a lawyer with the National Senior Citizens Law Center, based in Oakland, Calif.

The problems go beyond technical difficulties, such as when computer databases fail to note that a beneficiary is enrolled in a plan. In some cases, private plans are just not following guidelines established for their participation.

The plans are not issuing emergency supplies as required and they have set up prohibited restrictions on the types of medicine that beneficiaries can get during the first weeks of the program, according to the American Psychiatric Association.

‘’Relapse, rehospitalization and disruption of essential treatment are some of the consequences of the bureaucratic nightmare,’’ said the association’s president, Steven Sharfstein. ‘’I commend those states and other jurisdictions that have taken steps to assure that patients receive their medications in a timely manner.’’

Peri Jude Radecic of the Arizona Center for Disability Law spent much of last week lobbying Napolitano and state lawmakers to take action and ensure that AHCCCS-Medicare patients were covered.

"These people need their medications and they need them now," she said. "We cannot have people who don’t take their seizure medication ending up in the ER."

McClellan said he has directed plans providing drug coverage to make it easier for pharmacists to resolve questions about a beneficiary.

‘’I’ve been in touch with the health plans today and they are setting up expedited processes for pharmacists to contact a plan without waiting in a long queue. The plans are setting up those systems right now,’’ he said.

McClellan said plans were required to provide a 30-day supply of drugs, even if their plan does not cover a particular drug. In cases when a drug is not on the list, plans require pharmacists to get preauthorization before dispensing the drug. Many plans are waiving the preauthorization requirements, he said.

McClellan also said he contacted several governors and the staff of the National Governor’s Association this past week on how best to help beneficiaries. Some lawmakers have demanded that the federal government reimburse states for those efforts, but McClellan said the insurers and other businesses offering coverage would do that.

‘’The plans are getting paid additional amounts to provide the extra coverage for the dual eligible beneficiaries. It’s a matter of reconciliation,’’ he said. ‘’If the state works with us . . . we can send that information onto the plan so the plan reimburses the state for the difference.’’

Medicare help

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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