Posted At Keepmecurrent.com
BY : Ken Tatro
When Lloyd and Loretta Parker went to the pharmacy at the South Portland Hannaford Tuesday, they discovered that, although they were ready to fill their prescriptions, the new federal prescription assistance program wasn't ready for them.Lloyd Parker was not even in the system, and Loretta Parker had some difficulty dealing with the new system. Lloyd Parker said he had called weeks ago and had been told they would receive their ID numbers by Jan. 1. But, as of Tuesday, they had not received them.
"These are all things we absolutely have to have," Loretta Parker said. "It really makes you angry with the government."
The Parkers were just two of the state's elderly who were caught up in the switch to the federal Medicare Part D drug plan something many had predicted would be a nightmare. Pharmacists struggled to fill prescriptions this week using a national database that, as of last week, didn't even list most of the Mainers enrolled in the program.
The Parkers had to spend $600 more than usual Tuesday to fill their prescriptions, before the couple left for Florida Wednesday. The Parkers had been purchasing their drugs from Canada, but stopped because of the new drug plan and are now reconsidering the move, saying that they are spending more now than they had been in the past.
"The federal government is not ready to turn this thing on," said Jude Walsh, the head of drug benefits in the governor's Office of Health Policy and Finance. "This is irresponsible. It's no way to run a pharmacy benefit."
Mainers who have enrolled, like most seniors across the country, have yet to receive their benefit cards under Medicare Part D, and are therefore bringing in letters to their pharmacies to verify their enrollment. Those that have forgotten their letters will be asking their pharmacists for help.
"Recipients themselves don't know what they signed up for and don't know what their benefit actually is," said Joe Bruno, former House minority leader and head of the Community Pharmacy drug chain. "It's tough for pharmacists to figure out what plan they're in and how to bill."
Locally, pharmacists reported some problems with the new program, mainly that customers did not have the necessary paperwork, forcing them to call the various insurers for the missing information.
But once the pharmacy gets the necessary information, the process seems to go fairly smoothly and overall customers seem agreeable to the change, said James Charest, pharmacy manager for the Rite Aid at Dunstan Corner.
"You don't expect a big change like that to be smooth," he said.
At the other end of the spectrum is Diana Jackson, a pharmacist at the Rite Aid in South Portland, who said the change over has been difficult.
Often times the companies offering the various drug plans have not been helpful to her staff when they request information and other times cannot be reached because of such a high call volume.
Jackson said customers are a bit frustrated, but she tries to work with them the best she can and offers enough medicine to hold them over until the situation is resolved.
"I think they should have given it more time and laid out how it was going to happen," Jackson said.
Medicare Part D went into effect on New Year's Day. While all Medicare-eligible seniors can sign up for the drug plan and have until May 15 to do so without penalty the first group to enroll were those elderly poor, who had been getting drug coverage under Medicaid or other state assistance programs like Drugs for the Elderly in Maine.
Those state programs had been serving 80,000 people, and Walsh's office helped enroll most of them in Medicare Part D since federal subsidies for state-run drug programs stopped as of Jan. 1. The problem is only 22,000 or so seniors were actually entered into the Medicare database as of last Thursday, making it tough for pharmacists to verify eligibility when customers started coming in this week to buy their drugs under the new plan.
Many others who were purchasing medication using the new Medicare program reported a great deal of frustration with the system. Overall most people felt a sense of confusion with the new program, both using it now and enrolling in the program.
"I went to five different colleges, and I couldn't figure it out," said Scarborough resident Harvey Warren. "I'll check with it later when they figure it out."
Others were happy they did not have to deal with the program or handle any of the changes that thousands of Maine residents had to undertake.
Walter Weyrauch, of Cape Elizabeth, receives his medication from the Department of Veterans Affairs and did not even investigate the changes to the Medicaid system because he feels he gets a good deal from the organization and has a low co-pay.
Medicare D is really nine different plans all with their own rules about what drugs are covered at what deductible and co-pay since the federal government is contracting out this new pharmacy benefit with private insurers.
"We're used to having one contractor, and the pharmacists are used to having one provider. Now we have nine plans in three time zones," Walsh said. She said a special pharmacy hotline was being set up to help druggists confirm eligibility.
Wading through a myriad of plans is even tougher for those who are not being enrolled with the help of the state. More than 100,000 seniors in Maine, who had no government-subsidized drug coverage before, have to choose among 41 different plans and find the one that best fits their medical needs and ability to pay. Reports show that nationwide this group did not rush to sign up by Jan. 1, but instead will take the time between now and May 15 to decide.
While the federal government was ready to automatically and randomly enroll seniors who had been getting drug coverage under Medicaid, Maine opted to take over that enrollment process. The state wanted to make sure the plans they were assigned were the best fit possible for the medications they currently are taking.
The state also opted to enroll low-income seniors making up to 185 percent of poverty who were not on Medicaid but taking advantage of the state subsidized Drugs for the Elderly program. In order to do that, the state agreed to pay their premiums, totaling more than $10 million.
Five different letters have gone out to the seniors the state has enrolled in Medicare Part D and that could add to the confusion at the pharmacy counter. Recipients flooded a state hotline with 50,000 calls over three days after the first round of notices went out and thousands of calls were still coming in daily as of last week.
Chris Gauthier, a pharmacist with Miller Drug of Bangor and president of the Maine Pharmacy Association, said he believes the state is trying to do the right thing.
"The state has screwed up quite a few things when it comes to pharmacies. This doesn't seem to be one of them yet," Gauthier said.
