[Winona Online Democracy]
This is an open letter to our Winona area State Legislators and Governor
Pawlenty.
Below is an article about some states, including our neighbor North Dakota,
who are intervening to assure that low income persons will not go without
necessary medications due to the problems with how the private HMOs are
implementing Medicare Part D. Elderly as well as persons suffering from
mental illness, mental retardation and physical disabilities are running
into problems with obtaining medications. Pharmacies are being overwhelmed
with the problems. Even the nursing homes are now being told by many
pharmacies that their residents will have to go elsewhere for medications
because they cannot afford to meet the new long term care Part D
requirements.
PLEASE do something ASAP in our great state of Minnesota to stop this
problem before people die or are unnecessarily hospitalized.
Craig Brooks
Winona, MN
(Director, Winona County Dept. of Human Services)
******************************
January 8, 2006
States Intervene After Drug Plan Hits Early Snags
By ROBERT PEAR
WASHINGTON, Jan. 7 - Low-income Medicare beneficiaries around the country
were often overcharged, and some were turned away from pharmacies without
getting their medications, in the first week of Medicare's new drug benefit.
The problems have prompted emergency action by some states to protect their
citizens.
Although there are no hard numbers, concerns expressed by state officials
and complaints from pharmacists suggest a widespread pattern of problems.
At least four states - Maine, New Hampshire, North Dakota and Vermont -
acted this week to make sure poor people received the drugs they were
promised but could not obtain through the federal Medicare program.
Gov. Jim Douglas of Vermont, a Republican, said the state would pay drug
claims for low-income people until the federal government fixed problems in
the new program, known as Part D of Medicare. Michael K. Smith, the state's
secretary of human services, said, "The federal system simply is not
working."
On Thursday, the Vermont Legislature passed a bill declaring, "There is a
public health emergency due to the federal implementation of Medicare Part
D, which has resulted in serious operational problems, causing Vermonters to
be turned away at the pharmacy without the drugs they need."
Many factors contributed to the initial chaos. Some people who enrolled in
Medicare drug plans did not have any proof of coverage. Pharmacists could
not get the information needed to verify eligibility for drug benefits and
low-income subsidies. Insurance companies and their pharmacy benefit
managers were swamped with calls, so pharmacists often had to wait an hour
or more on telephone help lines.
Federal officials promised improvements, but state officials were growing
impatient.
In Maine, Gov. John Baldacci, a Democrat, agreed to pay drug claims to
provide medications for those in need. Since Tuesday, the state has incurred
$2 million of expenses for Medicare beneficiaries.
On Friday, Gov. John Hoeven of North Dakota, a Republican, said he had to
act because "some low-income elderly and disabled individuals can't get
their prescriptions filled through their Medicare drug plans."
In New Hampshire, Gov. John Lynch, a Democrat, signed an executive order
authorizing the state to pay drug claims that he said should have been
covered by Medicare. Republican leaders of the state legislature called a
special session to provide the money. The start of the Medicare drug program
"has been a nightmare for many of our citizens," Governor Lynch said.
"Many are being charged unaffordable co-payments for prescription drugs -
co-pays much higher than they are supposed to be. Too many of them are
leaving pharmacies without their prescriptions."
Thomas T. Noland Jr., a spokesman for Humana Inc., a major national insurer,
said that some problems were "to be expected in a new program with lots of
new enrollment taking effect all at once."
Cynthia G. Tudor, a senior Medicare official, told insurers on Wednesday
that they must "immediately make improvements" to "ensure that all
beneficiaries get their prescriptions filled at the point of sale."
In a memorandum to insurers, Ms. Tudor said she had received "numerous
reports" that they were "inappropriately denying some scripts," or claims.
In many cases, she said, insurers are not providing the data that pharmacies
need to file claims and get paid.
Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and
Medicaid Services, said on Saturday that he was working closely with states
to address their concerns and to help individual patients. "We are filling
close to a million prescriptions a day, including hundreds of thousands for
low-income beneficiaries," Dr. McClellan said. "Many, many people are
getting the prescriptions they need."
But in an interview on Friday, Stan Rosenstein, the Medicaid director in
California, said: "We are hearing more and more complaints. A significant
number of people are not getting their prescriptions. That has us very
troubled."
Drug benefits are delivered by private insurers under contract to Medicare.
The federal government is supposed to compute the subsidy available to each
low-income beneficiary. But Michael Polzin, a spokesman for Walgreens drug
stores, said that, in many cases, that information had not been shared with
insurers or pharmacists.
Under Medicare rules, each drug plan is supposed to have a transition
policy, providing a temporary supply - typically 30 days - of any
prescription that a person was previously taking. But customer service
representatives at Medicare's toll-free telephone number said they knew
nothing of this requirement, and beneficiaries said it had been virtually
impossible to take advantage of it.
Nationwide, 6.2 million low-income people receive both Medicare and
Medicaid. About 1.1 million of them live in California. They tend to have
many chronic illnesses and high drug costs. Cheryl Meronk, manager of the
health insurance counseling program in Orange County, Calif., said she was
referring people to hospital emergency rooms because they had been unable to
get urgently needed medications through Medicare.
Under the standard Medicare drug benefit, which took effect on Jan. 1, the
patient pays a $250 deductible and 25 percent of the next $2,000 in annual
drug costs.
Over the last year, Medicare officials repeatedly assured poor people that
they would receive extra help, so they would not have to pay any deductible
and their co-payments would not exceed $5 a prescription.
But Carol A. Herrmann-Steckel, commissioner of the Alabama Medicaid Agency,
said that Medicare beneficiaries with very low incomes had often been
required to pay the full $250 deductible and co-payments far exceeding $5.
"One beneficiary borrowed the money," she said. "Another charged the $250 on
a credit card because she was in such dire need of the medicine."
Beverly R. Churchwell, an aide to the Alabama commissioner, said: "Some
Medicare beneficiaries have not been able to get their medications. They are
being turned away at the pharmacy."
John J. Morris, 42, of Ware, Mass., who has diabetes and multiple sclerosis,
signed up for a Medicare drug plan on Nov. 16. The insurer told him his
co-payments would not exceed $5, he said, but at the pharmacy this week, he
was told he had to pay $23 for each of three drugs.
"I could not afford it," Mr. Morris said, "so I was not able to get my
insulin or my M.S. drug."
In Oregon, Sandy K. Hata, a field manager for the State Department of Human
Services, said: "We've had calls from people in tears who could not get
their medications. These people were being asked to pay a $250 deductible
and hundreds of dollars in co-payments."
Jane-ellen A. Weidanz, the Medicare project manager at the Oregon Department
of Human Services, said, the $250 deductible "is hitting people very hard,"
adding: "People are very angry and very upset. They are yelling at us. They
feel that we lied to them. They feel Medicare lied to them. They feel they
cannot trust anything we say about this program."
Texas reported a similar problem. Low-income beneficiaries are "being
charged incorrect (high) co-payments," the state's Health and Human Services
Commission said in an e-mail message to the Dallas office of the federal
Medicare agency.
In Oklahoma, low-income Medicare beneficiaries were often charged the $250
deductible. "They are being treated as if they were in a higher income
bracket," said Mike Fogarty, chief executive of the Oklahoma Health Care
Authority. "It's a common problem."
Steven E. Hahn, a spokesman for AARP, which offers a drug plan insured by
UnitedHealth Group, said he knew that some low-income people had had
difficulty getting medications. "We are taking this very seriously," he
said. "This is a global problem, a systemwide problem, for all plan
sponsors."
Elizabeth L. Stone, 86, who lives alone in an apartment in Manchester, N.H.,
is enrolled in both Medicare and Medicaid, has arthritis and a thyroid
ailment and is in a wheelchair. She tried to use the new Medicare benefit to
fill a prescription this week, but failed.
"I did not get any medication," Ms. Stone said. "People at the pharmacy
would not give it to me because they do not know how they will be
reimbursed."
Another low-income beneficiary, Terence J. Stevens, 65, of Lakeland, Fla.,
said he signed up for the drug plan on Nov. 15, the first day on which
enrollment was allowed. His plan tried to charge him a $47 co-payment for a
drug to treat irregular heartbeats and high blood pressure. Mr. Stevens said
he was unable to pay and did not get the drug.
In Alabama, William M. Beasley, a pharmacist and a Democratic member of the
State House of Representatives, said, "I have had more difficulty trying to
process claims for Medicare recipients than I've had with any other insurer
in 43 years as a pharmacist."
* Copyright 2006The New York Times Company
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