Published: February 08, 2006 04:07 pm      

Medicare changes off to a bad start

"The D is for disaster," says pharmacist

The new prescription drug benefit for Medicare that took effect on January 1 is the most significant expansion of Medicare since creation of the program in 1965. So no one expected things to go smoothly, but few expected things to go as wrong as they have.

“It didn’t work,” said Stan Hogan, pharmacist at Jackson Drug Company. “On the first day, the computer crashed so we all had to use 1-800 numbers to call in with questions and problems. But there were so many calls that the entire 1-800 network crashed in the southeast. For a while, no one could call any 1-800 number in the southeast. We were off-line for two days. It was that bad.”

The major problem lies exactly where Hogan and other pharmacists had anticipated: with those who are dual eligible for both Medicare and Medicaid. Those customers who did not sign up for a new prescription drug plan carrier were automatically signed up for a carrier on January 1. The problem there is that many of the government-approved carriers do not service all regions of the state. As a result, these people – people who need medication regularly – could not immediately obtain their prescriptions.

Since the program began on January 1, many low-income people have left pharmacies empty-handed after being told they would have to pay co-payments of $100, $250 or more, according to national reports. That has not been the case in Jackson as local pharmacists and their staffs have worked through the problems and long waits to make sure their customers get the medications they need.

“We haven’t kept anyone from getting their medication,” reported Danny Patterson at City Pharmacy last week. “We’re taking a chance that we’ll get paid correctly. These are people who are dual eligible and have two letters with them. We can’t get through to find out which is the correct carrier. We still can’t get through to most of the phone lines. We’re working it out, but it’s going to take a while.”

About 20 states have announced that they will help low-income people by paying drug claims that should have been paid by the federal Medicare program.

The president of MemberHealth, which offers three national Medicare drug plans, including Community Care Rx, has apologized to pharmacists for problems that plagued the new benefit.

"We expected much more of ourselves, and certainly our performance in the first two weeks was a disappointment," the company's president, Charles E. Hallberg, said in a letter sent last week to pharmacists. "For that, I want to personally apologize to each of you."

He acknowledged that drug stores "have experienced unacceptable wait times for customer service because we were unable to keep up with the extraordinary call volume."

“It’s been pretty much a nightmare,” said Patterson.

Hogan did one better, calling the start of the prescription drug plan “an absolute ridiculous nightmare.”

Anyone with questions or concerns about their Medicare or Medicaid coverage is asked to speak to their local pharmacist.