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States step in as Medicare drug plan falters

/ Source: news services

California, Arkansas and Illinois have joined about half a dozen other states taking emergency measures to help residents struggling to get prescriptions filled under the new Medicare drug program.

California Gov. Arnold Schwarzenegger ordered an emergency plan Thursday allowing the state to pay for the drugs for the next two weeks.

The state will temporarily supply seniors and the disabled with “lifesaving medications they are in danger of losing because of significant problems with the new federal Medicare prescription drug program,” Schwarzenegger said in a statement.

Gov. Mike Huckabee declared a public health emergency in Arkansas on Wednesday and announced the state would provide short-term aid to pharmacies to help get medicines filled.

"It's become apparent that there are a number of people in our state, particularly the elderly and the most frail, who are in a life-or-death risk over getting medication," Huckabee said.

Illinois officials sent notices to pharmacies Wednesday detailing where to call if Medicare patients can't get medicine. If the problem can't be resolved by phone, pharmacists will be allowed to bill the state for the cost of the drugs, officials said.

“It’s unacceptable that any Illinois senior or disabled person who is entitled to Medicare’s low-income drug coverage is leaving pharmacies without the prescription drugs they depend on,” Gov. Rod Blagojevich said in a statement.

Rhode Island officials also said they plan to launch an emergency program.

"When he didn't have it all fixed, we started realizing that we had to keep scrambling," Huckabee said.

The governor estimated Arkansas would spend between $2 million and $6 million to help pharmacies fill prescriptions that the new federal program is rejecting. He said he hoped the federal government would reimburse the state's expenses.

Centers for Medicare and Medicaid Services Administrator Mark McClellan said Thursday states should contact Medicare for help before using their own money, which the agency cannot reimburse by law. The agency is also trying to help some states get reimbursed by companies offering the plans.

UnitedHealth Group, WellPoint Inc, Humana Inc, Walgreens, CVS Corp and Walgreen Co are among those either offering or marketing coverage.

“We’re working around the clock and around the country to make sure everyone can get the prescriptions they need,” McClellan told Reuters.

Vermont, Connecticut, Massachusetts and North Dakota had already announced plans to help low-income residents get their medicine if pharmacists were having trouble confirming coverage through the new Medicare benefit.

Enrollment expected to increase

Despite the initial glitches, enrollment for Medicare’s new drugs benefit is expected to beat expectations this month, the head of the federal insurance program said Thursday.

McClellan said he expected “significantly more enrollment” by the end of January than the 500,000 he had anticipated by then when talking to reporters last month.

“I think we’re well past that,” McClellan said at the Reuters Regulatory Summit, held in Washington. He added that officials saw a surge in sign-ups in late December ahead of the program’s Jan. 1 start.

McClellan acknowledged that thousands of Medicare’s elderly and disabled beneficiaries have faced some trouble so far filling prescriptions under the benefit.

Most affected were those automatically switched to the new coverage from Medicaid, the joint federal-state program for low-income Americans, he said. Some others who switched plans in late December also were involved.

“A few thousand” beneficiaries have had difficulties that required Medicare case workers to step in to fix the problem, McClellan said.

In some case, people who enrolled in plans have discovered they aren't listed as participating when pharmacies check their computers. Other beneficiaries found they were listed as owing a $250 deductible when they should have been paying only a few dollars per prescription.

‘Nightmare situation’

Consumer advocates have complained that computer and other errors have left many patients with life-threatening or chronic conditions without needed medicines.

Jocelyn Guyer, a senior program director at the Georgetown University Health Policy Institute, told a group of reporters it has been “a nightmare situation for many of these people.”

The new benefit, which allows insurers, pharmacies and other companies to offer drug coverage, has drawn criticism over its hefty price tag since it became law in 2003.

A White House estimate released last year said it would cost $724 billion for the 10 years starting in 2006.

McClellan said earlier projections were based on anticipated costs but new data indicate actual costs will be lower.

“I am pretty confident, based on the numbers we’ve seen so far, that the numbers are going to be less than what a lot of analysts predicted,” he said. Those figures are expected by the end of February, he added.

Still, some critics said the benefit is not doing enough to help people who did not have coverage.

“This program, with such large expenditures, is only adding a small number of people to drug coverage,” Ron Pollack, head of the advocacy group Families USA, told Reuters on Wednesday.

Out of the 21 million beneficiaries enrolled so far, most already had coverage and were switched by their employer, the military or other payers. One million enrolled voluntarily.

Government numbers released earlier this week showed Medicare spending growth rose 8.9 percent in 2004, without the new benefit.

McClellan said efforts to boost preventive care and other steps would help control Medicare spending overall.