Prescription plan continues to confuse

Thursday, January 26, 2006

Last November, senior citizens across the nation worked through a list of confusing variables to select a prescription plan under the new Medicare D prescription drug plan.

"We have a good support system in Cassville," said Linda Parker, Barry County Senior Citizens Center administrator. "Our local pharmacists did an outstanding job of educating our seniors. The senior center had meetings and the Southwest Missouri Office of Aging came down to talk to people."

Organizations, individuals and companies across Barry County joined together to help area seniors select the Medicare prescription drug plan that will best fit their individual needs.

Louis Metz, of Sater Pharmacy in Cassville, invited Mark Smith, of Willis Insurance, to spend a week inside the pharmacy advising patients on selecting a Medicare prescription plans.

"Pharmacists cannot make suggestions of which plan to enroll in," said Metz. "I gave a list of the patients' prescriptions to them and Mark talked to them about the plans and signed a lot of them up."

Even with all the instruction and advisement, many seniors remained apprehensive about the changes in Medicare coverage.

"I feel like for the most part they understand the plan," said Parker, "but there is still a lot of confusion out there."

"I can understand them being apprehensive," said Parker. "They are on a fixed income and they just look at it as another payment."

Blake Whitley, owner of Whitley's Pharmacy in Cassville, also took steps to prepare for the Medicare D prescription plan start day.

"We tried to be ready ahead of time," said Whitley. "We had as much information from the companies as we could, but we started at square one the first day."

On Jan. 1, all the hard work, extra hours, fear and apprehension were put to the test when the new Medicare D system went on-line.

"This is the worst implementation I've ever seen in my 24 years of experience," said Metz.

"The government should have never allowed it to be as complicated as it is," said Whitley. "When they let people play with so many variables and have so many companies involved, it is a logistical nightmare."

As the new system went on-line, pharmacists experienced a wide array of problems, which became further complicated when telephone lines jammed from call overload.

"An insurance company that I signed up with months ago told me that I was not an authorized pharmacist," said Metz. "I've had patients with Medicare cards in hand and the system says their insurance is not available. I've had others that their co-pay exceeds their deductible."

One of Metz's patients was told that he had a $1,736 co-pay. Metz spent 30 minutes on the phone with the insurance company to reduce the co-pay to $3.

"If they don't have the card or a letter with their group number and other information, they are generally not set up in the system so you don't know who to send their information to," said Whitley. "It was real frustrating to the customers because they had their card in hand and it wouldn't work or they were enrolled incorrectly."

Metz talked to one pharmacist who admitted he was considering leaving his career because of problems with the Medicare D system.

"Medicare was behind in providing information to the insurance companies," said Whitley. "They had incorrect co-pays and deductibles. It was total chaos. The system was just not ready. It needed another year to get ready."

Software companies worked as quickly and efficiently as possible to clear up problems, but they too were overwhelmed, said Whitley.

Metz solved most of his problems by filling prescriptions and hoping to recoup expenses when the system is fixed.

"Our seniors are not even aware of how severe the problems have been. We're giving them the benefit of the doubt," said Metz. "The patients can't do anything about it. The 1-800-MEDICARE number is an hour on hold."

Patients continue to experience other problems due to the unpredictability of the new Medicare prescription formu-laries, said Metz.

"On Jan. 1, all the formularies were in place and by Jan. 5 one had already changed their formulary," said Metz. "They're going to be told to find a plan that will fit their formulary, but that isn't right because the formulary will change. Once it is published, it is already out of date."

"It is bewildering to anyone," said Whitley. "If they sign up with one company and find out that one doesn't cover their prescriptions, it is hard to find another. Then the formularies can change in 60 days and their prescriptions are not covered again."

Local doctors have cooperated with pharmacists by prescribing medications that are covered by the patients' Medicare plans or changing prescriptions to help patients avoid higher prices.

"I have talked to the administrator of Medicare about these problems, and I will continue to monitor their progress on correcting them," said Congressman Roy Blunt. "Medicare is making a good faith effort to correct them as quickly as possible on a case-by-case basis."

Some insurance companies have promised reimbursements to seniors who have been charged incorrect co-payment amounts, said Blunt.

"This is not unusual or a surprise in a program that will serve millions of seniors," said Blunt. "A million seniors signed up for stand-alone plans in just 28 days."

"Remember, when Medicare started in 1965, there were reports of confusion, patients and doctors didn't understand the new program and seniors were complaining that they had not received their new Medicare cards," said Blunt. "I am confident the system will work things out and provide the services promised."

Whitley agrees that system problems are decreasing, but believes it will take 60 to 90 more days to have the entire Medicare system working properly.

"A large percentage of Medicare seniors and citizens will be able to more easily afford their prescriptions," said Whitley, "but it is not going to help healthcare costs. It is good that it is set up with a premium, because we can't afford the tax burden of the program."

"Every senior gets at least $1,500 worth of benefits," said Metz. "That is $1,500 that they didn't have prior, but it looks like they cut Medicaid to fund the increase in Medicare benefits."

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