Originally created 01/18/06

Persistence prescribed on Medicare

While Augusta pharmacists still struggle to make the new Medicare prescription drug benefit work, top health officials pledged Tuesday to help patients get the drugs they need.

Mike Leavitt, U.S. secretary of Health and Human Services, said during a conference call that federal agencies and private drug plans have sorted through "tens of thousands" of complaints from those trying to use their new Medicare prescription drug coverage, which started Jan. 1. Within the past 30 days, 2.6 million people have enrolled, with 20,000 joining online every day since early January, he said. Nearly 24 million are using the prescription plans, and 1 million prescriptions are being filled every day.

"When millions are enrolled all at the same time, there are bound to be some transition problems," Mr. Leavitt said.

Many of the problems arise from the 6.8 million "dual eligibles" who qualify for both Medicare and Medicaid and were automatically enrolled in plans. The states are supposed to cover the premiums, and there is not supposed to be a deductible. But sometimes the plans don't have those patients listed that way, said David Pope, of Barney's Pharmacy in Augusta.

"Initially, we had a lot of folks who were dual eligible, but whenever we run it through the insurance, they say she needs to pay this amount of deductible," he said. "So a lot of those folks at the current time were unable to pay for that. So, we're an independent pharmacy. We help out our folks. A lot of it boils down to, well, this lady can't afford $60."

At Hill Drug Co., a basket holds about $20,000 worth of claims for which the pharmacy has not been reimbursed, said pharmacist Brooks Rode.

"How are we going to pay our bills?" she asked.

Mr. Leavitt said the government knows there is a problem but Medicare patients should not go without.

"If you are one of those seniors experiencing problems, our message is: Don't leave the pharmacy without your drugs," he said. "There are a lot of things that can be done to make sure that you get your prescriptions filled, and there is no reason for you to go without your medicines - medicines that you need - or for you to have to pay more than you owe."

Pharmacists have access to a toll-free help line, or Medicare patients can call (800) MEDICARE, and there are hundreds of caseworkers available to help work out problems, said Mark McClellan, administrator of the Centers for Medicare and Medicaid Services.

The new health plans must cover the first prescription, regardless of whether it is on their approved drug list, and the plans have been told to improve their service so pharmacists can fill those prescriptions, Dr. McClellan said.

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

Call For Help

Federal health officials say Medicare patients using the new prescription drug plan should not have to leave pharmacies empty-handed. Call (800) MEDICARE for help.


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