Some patients using Medicare’s new drug benefit reported difficulties Tuesday in filling prescriptions, though the government and some large pharmacies and nursing homes said the program was off to a good start.
The plan, estimated to cost the government $724 billion over the next 10 years, will subsidize medicine costs for tens of millions of older Americans and the disabled.
Jack Silverman of Short Hills, N.J., visited his local Walgreens pharmacy first thing Sunday and tried to fill two prescriptions. He was stunned when the bill came back showing he owed twice what he had been paying — $255.52 instead of $119.79.
Silverman said he knows there could be a good explanation for the bill, which he declined to pay. But he could not reach anybody Sunday or Monday associated with the federal government or his insurance provider who could take his call.
“I’m really disappointed the system didn’t take into consideration that Sunday was New Year’s Day and Monday was also a holiday,” Silverman said. “People who really needed their medication could have been at a loss.”
However, Kevin James, the national accounts manager for more than 3,700 pharmacies operating in Wal-Mart and Sam’s Club stores, said the reports he received nationwide indicated the new program was off to a good start.
“I don’t know if we knew what to expect,” James said. “I would say it’s gone pretty well.”
Officials were most concerned about ensuring that 6.2 million people previously getting their medicine through Medicaid were in the new program. The “dual-eligible” population is generally frail and has extensive medication needs.
Working out the kinks
Bruce Roberts, CEO of the National Community Pharmacists Association, said that pharmacies often had trouble determining on Sunday and Monday whether their dual-eligible customers were enrolled in the new program. However, the problem was easing Tuesday.
“We knew it was going to be difficult,” Roberts said. “But people are getting their medicine, and that is the bottom line. It will take a couple weeks to work out the kinks.”
Mark McClellan, administrator of the federal agency overseeing the new benefit, said a late surge in enrollment made it difficult to process all applications before Jan. 1. The surge led to delays when pharmacists and nursing homes tried to determine billing information. However, by Tuesday afternoon, computers were processing 10,000 eligibility queries an hour.
“There clearly have been some bumps, especially yesterday when some pharmacists had delays in accessing the electronic information systems we set up,” said McClellan, head of the Centers for Medicare and Medicaid Services. “Today, we’re not seeing any of those delays.”
McClellan said he has heard complaints as well as success stories from all over the country. In particular, he said a pharmacist from Arkansas told the agency that one of his customers no longer had to limit how many prescriptions he could take — as was the case under Medicaid.
“We had more than a million dual-eligibles in nursing homes getting their drugs on schedule with their prescriptions handled,” McClellan said. “We’ve had hundreds of thousands of prescriptions filled for many thousands who had no coverage before.”
Thomas Clark, director of policy and advocacy for another pharmacists’ trade group, said many pharmacists could not verify which plan patients were enrolled in, so they provided enough medicine to last a few days. Telephones for many private insurers were also overloaded.
“The system was overwhelmed,” said Clark, of the American Society of Consultant Pharmacists.
A trade group representing not-for-profit nursing homes said that to the best of its knowledge, implementation of the new benefit has gone smoothly.
“Since the Jan. 1 rollout of the new benefit, we have had reports from a limited number of our members of problems in the first few days, but CMS has worked to fix them,” said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging.