With tens of thousands of people unable to get medicines promised by Medicare, the Bush administration has told insurers that they must provide a 30-day supply of any drug that a beneficiary was taking before the program began this month, and it said poor people must not be charged more than $5 for a covered drug.
The actions came after several states declared public health emergencies and many states announced that they would step in to pay for prescriptions that should have been covered by Medicare.
Republicans have joined Democrats in asserting that the federal government botched the launch of the prescription drug program, which started Jan. 1. Some people who had signed up for coverage found they were not on the list of subscribers.
Insurers said they had no way to identify poor people entitled to extra help with their drug costs. Pharmacists spent hours on the telephone trying to reach insurance companies that administer the drug benefit under contract to Medicare.
Many of the problems involve low-income people entitled to Medicare and Medicaid.
In a directive sent to all Medicare drug plans over the weekend, the Bush administration said they “must take immediate steps” to ensure that low-income beneficiaries are not charged more than $2 for a generic drug and $5 for a brand-name drug.
In addition, it said insurers must cover a 30-day emergency supply of drugs that beneficiaries were taking prior to the start of the new program. The requirement for a “first fill” of any prescription applies to all beneficiaries, regardless of income.
In an interview on Sunday, Dr. Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said “several hundred thousand beneficiaries who switched plans” in December may have had difficulty filling prescriptions in the past two weeks.
In California, officials estimate that 200,000 of the state’s 1.1 million low-income Medicare beneficiaries had trouble getting their medications.
Despite these problems, McClellan said, Medicare is now covering 1 million prescriptions a day. With the latest corrective actions, he said, “all beneficiaries should be able to get their prescriptions filled.”
In the past, such predictions proved to be premature. New problems appeared as old ones were solved, and some insurers were slow to carry out instructions from Washington.
Since the program began, many low-income people have left pharmacies empty-handed after being told they would have to pay co-payments of $100, $250 or more.
Several states have announced that they will help low-income people by paying drug claims that should have been paid by Medicare.
“The new federal program is too complicated for many people to understand, and the implementation of the new program by the federal government has been awful,” said Gov. Tim Pawlenty of Minnesota, a Republican.
On Saturday, he signed an emergency executive order making the state a “payer of last resort” for the out-of-pocket drug costs of indigent Medicare beneficiaries.
The Bush administration said it was rushing to provide insurers with correct information about the extra subsidies available to low-income people enrolled in their plans.
“We sent files to all plans providing complete information on dual-eligible beneficiaries” entitled to Medicare and Medicaid, McClellan said. “The plans now have all the information in one place.”
The new drug benefit is the most significant expansion of Medicare since creation of the program in 1965.
The local story
In Colorado: When the new Medicare
drug program began this
month, Denver pharmacists reported
having a tough time filling senior
citizens’ prescriptions.
Background: About 37,000 low-income
elderly and disabled Coloradans
were automatically enrolled in
Medicare drug plans offered by private
health-insurance companies
before the program began Jan. 1.
But some people had not received
identification cards, and others
didn’t even realize that their plans
had changed, pharmacists said.
Where to find help: Seniors in the
Denver area with questions can
call the Medicaid customer-service
line at 303-866-3513. They also
can call 1-800-MEDICARE (633-42273).