WASHINGTON – Tens of thousands of elderly poor 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.
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.
Under the 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, which is 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, re-hospitalization 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.”
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.
The agency also updated information on Friday so pharmacists can more quickly reach plans, McClellan said.
He said Medicare also has caseworkers on hand for beneficiaries or pharmacists who are having trouble navigating the new benefit. They can call 800-Medicare for help, he said.
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