Just two weeks before the new Medicare discount-drug cards are supposed to take effect, a puzzling development is making it difficult for seniors to evaluate the cards: The drug prices keep changing.

A new government Web site lets people type in their ZIP Code and the drugs they take, and get information on which drug cards in their region offer the biggest discounts.
But consumers searching the site are finding that the listed price of drugs are different from week to week. Last week, for instance, a Des Moines, Iowa, senior checking out United Healthcare's U Share Prescription Discount Card would have found a month's supply of three commonly used drugs -- Lipitor for cholesterol, Celebrex for arthritis and Prozac for depression -- listed at $231.17. This week, the same drugs were listed at $220.73.

The fluctuating drug prices are making it difficult for seniors to calculate which card would provide the most savings. In addition, many seniors have signed up for a card based on drug prices that may no longer be accurate. Heightening the pressure, once seniors sign up for a specific card, they must keep it until the end of the year, when they can select a new one.

The rapid-fire changes are the result of a variety of factors. Medicare is fixing some early glitches that led to incorrect pricing. More pharmacies, with new prices and fees, are signing on to accept the cards. And card sponsors continue to bargain for better prices from drug makers and pharmacies as they compete for seniors' business. A United Healthcare spokeswoman cited such bargaining, along with technical changes, as the reason for the difference on the U Share card.

Some prices have risen but, overall, Medicare officials figure that prices on the site declined about 12% last week from the previous week.

Medicare officials say they expect the price fluctuations to slow sharply in coming weeks, and that seniors might want to let prices stabilize before choosing a card. "There's no deadline for signing up; there's no late fee," says Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. "People can wait as long as they want." (Though those whose low incomes qualify them for a $600 credit should consider making a decision soon, he noted.)

Interest in the discount-card program has been intense. Last week, there were more than seven million hits on the price-comparison Web site, (www.medicare.gov2), Medicare officials say. In addition, the agency received 1.6 million calls on its 1-800-MEDICARE hot line -- more than 10 times the regular volume -- from people who can't or don't want to use the Internet. In response to complaints from callers that they can't get through, the government is increasing the number of operators taking the calls to 1,800 from about 400 last summer. Medicare also is urging people to call late at night or on weekends to avoid a long wait.

According to Dr. McClellan, "many thousands" of people have selected one of the cards, which go into effect June 1 and can carry enrollment fees of up to $30.

Some card sponsors complain that the Medicare site has provided an inaccurate picture of which cards provide the best deals. For example, a hypothetical Washington, D.C., senior looking for a month's supply of Lipitor, Celebrex and Prozac would have been quoted a price of about $221 on the Medicare site last week with the PBM Plus Senior Care Card. PBM Plus Inc., which sponsors the card, says that price is correct. But this week the price is listed as $223, despite the fact that PBM Plus sent identical price data to Medicare both weeks, says Mark Weiss, a vice president at the Milford, Ohio, company. Medicare officials say the site's search tool was changed to narrow the geographic area that it covers. So different pharmacies with different fees may be coming up from week to week.

Such price changes have been common. Consider that Washington resident taking the basket of three drugs. For the Precision Discounts card offered by WellPoint Health Networks Inc., the site showed the price at $248.72 to $255.25 for the first week, depending on the pharmacy used. The next week, however, the cost fell to $219.37 to $225.38. This week, it bounced up to $223.97 to $230.05. A Wellpoint spokeswoman said the company had added more pharmacies after the first week, but she couldn't explain the change for the third week because the company' own data hadn't changed. A Medicare official didn't know the reason for the difference.

The fluctuations are "a little distressing because people are going to get locked in to those choices" for the rest of the year, says Bonnie Burns, of California Health Advocates, which receives federal and state money to educate seniors on their benefits.
The cards, sponsored by insurers like WellPoint, pharmacy benefit managers such as AdvancePCS Health L.P. and groups such the Pharmacy Care Alliance, a coalition of drug stores, were authorized by the new Medicare law as a way to help people with their drug costs before Medicare begins covering prescription drugs in 2006. Some are available nationally, while others are being offered only on a regional basis.
Medicare estimates that the cards are currently offering 11%-17% off retail prices for brand-name drugs and 30%-60% off generic medications.
Medicare officials also are planning improvements on the site in the next few weeks, including showing seniors the cost of cheaper alternatives for the brand-name drugs they take.

In the end, seniors and their families have to sift through the information and decide whether signing up for the cards is worthwhile.