Thursday, January 12, 2006

First Week of Medicare Part D "a disaster" in some states

"The opening week of the Medicare prescription drug benefit was a disaster." So said Judith Stein, executive director of the Center for Medicare Advocacy Inc. Not all states are having major problems with Medicare, but apparently Louisiana is one of the states where things aren't going well.

In Louisiana, the poor and elderly were getting prescriptions paid through the state's Medicaid plan. Now this has been taken over by Medicare. The take over has not been smooth.

This is from an article on the Baton Rouge Advocate newspaper site (found at

The problems reported by Department of Health and Hospitals Medicaid field staff include:
  • Participating pharmacy plans said CMS [Center for Medicare and Medicaid Services - Allan] has not sent them the lists of approved enrollees.

  • Informational letters CMS sent to Medicaid recipients apparently didn’t work.

  • “They (recipients) did not understand anything about Medicare Part D (pharmacy coverage) and did not know they were enrolled in a plan, much less which plan,” one staffer wrote.

  • Many callers said they did not receive the CMS notices or new cards, possibly due to disrupted mail service since the storms.

  • Pharmacists are not willing to fill prescriptions even though they can call a phone number to insure medication is dispensed during the first 30 days of the program.

  • Pharmacies are making clients pay for medications and telling them they won’t be reimbursed.

  • Some clients report that their medication “is not covered/too expensive under their assigned plan.”

That last point is exactly what Alana, my wife, said she was discovering during the sign up process. She's been swamped with Medicare calls this week, her first full week back to work this year (she took last week off). My boss has a friend who's a pharmacist in Shreveport, and he says the plan is a huge mess. The pharmacist said that they are running into people who, suddenly, discovered the plan they picked didn't cover a particular prescription. This was Alana's biggest fear, and one that seems to have been entirely well founded.

Louisiana isn't the only state having problems, but it's not universal throughout the country. New Hampshire, South Dakota, North Dakota, Vermont, Connecticut, and Massachusetts have announced plans that they will pay for prescriptions for affected seniors until the mess is sorted out. (Louisiana, which is already reeling from Katrina, is unlikely to be able to afford this kind of help.) There's no guarantee the federal government will pick up the tab later, either.

Arizona found that almost 20,000 low income people who were supposed to be automatically enrolled in the system were not. New Jersey spent $4.4 million of its own money January 6 until January 10 covering people due to Medicare screw ups.

Not all states report major problems. Florida, Georgia, and Wyoming think the process is going relatively smoothly, or feel that — as yet — no state response is needed.

The full article can be found here:

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