Posted At North Jersey

BY : Suzanne Travers

Pharmacist Tony Tiabi is so confident the government's new prescription drug benefit plan will help his customers save money in the long run that he's gone out to senior centers encouraging them to sign up.

But as the second month of the program, known as Medicare Part D, began last week, Tiabi said he continued to encounter problems filling prescriptions for customers enrolled in Part D plans. Some have had to pay more than expected because although their plans cover their medications, they do not cover them at the dosages prescribed by their doctors.

On Friday, Tiabi tried to fill prescriptions for two customers enrolled in AARP MedicareRx Plan, offered through United Healthcare and sponsored by AARP.

Both people had been told by plan representatives that their medications were covered, but were not asked specifics about their prescriptions, such as what dose they take and how often they take it. Tiabi discovered his patients were on a twice-a-day dosage and needed 60 pills, but that their plans would cover a maximum of 45 pills.

"We were advised in one case to tell the patient to get a prescription for 50 milligrams," he said. "The doctor had lowered the dose (to 25 milligrams) because the person was having side effects with the 50 milligrams, but was OK having 25 milligrams twice a day. They said why don't they get a bigger prescription and cut it in half. I told them that would destroy the integrity of the drug. In those cases where it's a sustained-release product, it's not advisable to cut it in half ... The other drug was even more bizarre because in that case it was a capsule, so there was no way to divide it in half."

Tiabi said he spent an hour on hold with the AARP plan and was told the customer's doctor could file an appeal in writing to get all 60 pills covered by the plan. If the appeal is rejected, the man would pay $1 a pill for the remaining 15.

"There's no professional involvement whatsoever," Tiabi said. "They've got a script in front of them with the rules and that's it."

A spokeswoman for United Healthcare confirmed that the plan covers only certain dosages of medication and requires enrollees to pay for dosages beyond that amount. Tiabi said he had encountered the problem with other plans and that seniors he spoke with had not been asked about dosages when enrolling.

Other area pharmacists reported problems getting through to Part D insurance companies and said some customers needed to fill prescriptions but had not yet received drug cards from their plans. Officials from the Centers for Medicare and Medicaid Services have said they anticipated problems at the start of February for people who enrolled in plans late in January or for dual eligibles -- meaning people on both Medicare and Medicaid who recently switched plans because they were automatically enrolled in a plan that did not cover their medications.

However some pharmacists said their ability to fill prescriptions had improved since the program began Jan. 1.

"There's still some problems, but basically it's working out OK," said John Dufleid, a pharmacist at Damiano Pharmacy in Clifton. "We try and bill Medicare Part D, but if we can't, we bill the state."

New Jersey, along with more than 20 other states, intervened in early January and began paying for the prescriptions of dual eligibles who were being denied coverage from their Part D plans because of computer glitches and delays in processing enrollments. As of Thursday, New Jersey had spent $31.8 million on 364,000 prescriptions, according to Suzanne Esterman, spokeswoman for the state Department of Human Services.

On Thursday, Centers for Medicare and Medicaid Services released data that indicates that hefty competition from private insurers had lowered the average monthly premium for Part D plans to $25, less than the $37 per month originally projected. CMS also reported the program would cost the government $678 billion over the next 10 years, lower than the $737 billion estimated last year but still higher than the roughly $400 billion estimated when Congress authorized the program in 2004.

Also Thursday, by a narrow 52-45 margin, the Senate rejected a bill to extend the deadline for enrollment in Part D past the current May 15 deadline to Dec. 31, in order to give seniors more time to understand the benefit. New Jersey Sens. Frank Lautenberg and Robert Menendez voted to extend the deadline.

Shirley Force, a specialist with the Passaic County Department of Senior Services, said her office is flooded with calls from people seeking help with Part D. Many are confused about the plan, she said.

"The biggest thing is, they share information with their friends and they want to get the plan their friend has," not understanding that plans cover different medications and that someone else's plan may not cover the prescription drugs they need, Force said.

Mary Kuzinski, director of the Senior Services Department, said some seniors have not yet received letters of "creditable coverage" from former employers and unions. Those letters let retirees know whether they can stick with their current prescription drug plans and not face penalties for late enrollment if they join a Part D plan after May 15.

Nevertheless, many Part D beneficiaries expressed satisfaction with the benefit.

Rose Gray, 58, a Paterson resident on Medicaid, said she was pleased with the Humana plan in which she was automatically enrolled.