Second in a two part series on Medicare Part D and the different experience of different income groups in the transition.
Nightmarish. Confusing. Frustrating. Stressful. Horrific.
These are just a handful of words used by Virginia residents to describe the recent change into the new Medicare Part D Prescription Drug Program.
Those using the new plan with a steady and substantial income have experienced little trouble with the switch that took effect Jan. 1, 2006.
But, for residents with mental health issues, with mental retardation or the poor, whose Medicare is paid for by Medicaid, the switch has been nothing but trouble.
"We have many clients who have not been able to obtain their psychotropic medications," said Liz Mills, licensed professional counselor with the division of aging and disability services for the Arlington County Department of Human Services. "Many of the medications are not available."
Because a majority of the clients Mills works with are on Medicaid, they were supposed to be automatically enrolled in the Medicare Part D program, she said. When it came time to get their prescriptions filled, Mills' clients learned there was no record of their plan in the pharmacists’ computers.
TO HELP RESIDENTS with Medicare complications who cannot afford the high price of medication, the Fairfax County-Falls Church Community Services Board has picked up the cost during the transition, said Mari de Leon, healthcare access specialist.
Because medications can range from hundreds to thousands of dollars a month, the Community Services Board is either covering the cost, refilling or dispensing medication to clients who cannot go without their prescriptions.
The Fairfax-Falls Church Community Services Board works with people with disabilities including people with mental retardation, patients with mental illnesses and people dealing with alcohol and drug addictions. Many of these clients are dual eligible — or on Medicaid and Medicare — and should have been enrolled in the new program automatically. That did not happen, said de Leon.
"A lot of our consumers find difficulties in pharmacies because there is a lot of disconnect between pharmacists and Medicare," she said. "They have found that pharmacists they have gone to are now too busy and not all have the time to hold on the line for 30 minutes or more to verify accounts."
For residents who are dependent on their medication to live, including diabetics, people with high blood pressure or residents undergoing drug and alcohol treatment, a day without medication is detrimental to their health.
"Some people are depending on the medication that is missing and go through withdrawals when they stop taking it," she said. "In our mental health clients the implication is large. Hospital beds will fill up."
Anticipating there would be some problems with the switch, the board created a Medicare Part D committee, which de Leon heads. Under that committee, 20 volunteers were assigned to deal primarily with Medicare coverage questions. This included helping clients choose the appropriate plan out of the 41 offered through the new coverage.
While hold times are getting shorter and things are slowly being fixed, many patients are still waiting for their coverage plans to be enacted. Others eligible residents are planning to enroll shortly, before the May 15 cutoff date.
"We anticipated there would be problems," said de Leon, "but we didn't expect it to be of this gravity."
"When I called CMS [Centers for Medicaid & Medicare Services], the line was either busy, there were long waits, or there was no information," said John Eklund, pharmacist and owner of Preston's Pharmacy in Arlington. "We were told by an electronic voice often to call back later when the phones were less busy."
Unable to fill prescriptions for clients without the proper documentation, pharmacists have turned away people in need. In the meantime, those clients are faced with the decision of going without their necessary medications, or paying hundreds of dollars out of pocket, hoping they will be reimbursed, although most do not have the funds available for that option.
One of Mills’ clients recently was faced with this decision. After learning from the pharmacist that there was no record of her Medicare Part D plan — even though she enrolled two months earlier in 2005 — the woman paid $300 out of pocket for the much-needed prescription.
But because her income is only $550, her rent check bounced. She was not immediately reimbursed for her purchase of the medication which should have been covered by Medicaid, Mills said.
Mills also learned the woman was not taking full dosages of her various prescriptions because she was worried if it ran out she would not be able to refill it.
"Some of these people have severe diabetes or heart disease," Mills said. "Going without medication, they could end up dying or end up in the hospital."
Now two months since the Medicare Part D Prescription Drug Program went into effect, there has been a mixed reaction among recipients to the new plan.
Medicare prescription drug coverage is insurance that covers brand name and generic prescription drugs. Medicare prescription drug coverage is intended to provide protection for people with high drug costs. Currently 8 million low-income seniors across the country are eligible for Medicare Part D. But, only 1.4 million have signed up.
ACCORDING TO THE DEPARTMENT of Medical Assistance Services — the department in charge of the Medicare switch — Virginia has experienced few problems with the change-over compared to other states.
During the first month the department's call center, specifically set up to handle Medicare questions, received 195 calls, according to department spokeswoman Nancy Malczewski. During the second month the center received 114 calls, Malczewski said.
But, pharmacists and health officials working closely with Medicaid and Medicare eligible residents report plenty of problems, some potentially life threatening.
"The first month at best could be described as chaotic if not nightmarish," said Eklund.
Since Jan. 1, 2006, Eklund has seen how the switch has affected his regular clients. The most common problem is that many do not have the proper paperwork to get prescriptions. This includes not having their Medicare prescription drug card, which must be present for a prescription to be filled. For his regular clients, Eklund has called the CMS line to locate and fix the disconnect. Often he has been told to leave a name and phone number and someone will call him back within three days. Those return calls rarely come, he said.
"For my regular customers I try to give them a five-day supply of medication and hope in the mean time things will get worked out," Eklund said. "After a while, pharmacists cannot keep handing out medications."