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Glitches Mar Launch
of Medicare Drug Plan
By Janet Adamy, The Wall Street Journal
January 4, 2006
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![[Medicare Diary]](marlau1.gif) GETTING YOUR MEDS
If you don't have your Medicare drug-plan card yet, bring at least one of these things with you to the pharmacy:
. The letter stating that you are enrolled in a Medicare drug plan.
. The name of the plan you enrolled in.
. A copy of your application to the plan.
. Photo ID and information on any previous Medicare or Medicaid coverage.
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As the government's huge new Medicare prescription-drug benefit gets under way, glitches in the administration of the benefit are forcing thousands of people to get by on short doses or pay out-of-pocket for their drugs.
The drug benefit, which aims to fill one of the biggest holes in Medicare, went into effect on Sunday for those who had signed up for a plan by Dec. 31. The Centers for Medicare and Medicaid Services says that some 21 million
beneficiaries are enrolled in one of the plans, which are administered by private providers and subsidized by the government. More than one million beneficiaries have successfully obtained their prescriptions since the plan took effect, according to the CMS. But a last-minute surge of people who registered just before the start of the year is prompting some slowdowns, says a spokesman for the agency.
Several drugstore chains, including Walgreen Co. and CVS Corp., say that the national computerized system for verifying benefits has been unable to process requests for thousands of seniors who say they should be covered. And pharmacists say that when they attempt to verify coverage directly with the health insurers and pharmacy benefit managers that administer the plans, they frequently get repeat busy signals. Both pharmacies were issuing free two- and three-day supplies of medication to carry over customers who didn't have proof of coverage.
The problems largely involve customers who haven't yet received their new drug cards. If customers don't have a card, pharmacists then turn to the verification system, run by private contractor NDCHealth, an Atlanta health-care information and technology company.
NDCHealth said there has been "a slowdown in the processing time" of some requests but that it has adjusted its system to handle the high volume of requests, according to spokesman Robert Borchert. "We don't believe that there's been any major glitches."
Walgreen, the nation's largest pharmacy chain by revenue, said the glitches, which started Monday, seemed to be easing as of yesterday afternoon. No. 2 chain CVS said its pharmacists were still encountering problems with the system as of late yesterday afternoon. "The system was certainly overwhelmed," said spokesman Mike DeAngelis.
CMS said there were virtually no glitches as of yesterday, although pharmacists were still reporting some problems.
Larry Kocot, senior adviser at CMS, says that beneficiaries who haven't yet received their cards proving they're in the program should bring their pharmacists the letter saying they are enrolled, which should make it easier to process their prescriptions.
Customers lacking both those documents should try to remember which plan they applied to or bring their pharmacist a copy of their application to the program. Without those, customers should at least bring a photo ID and any information on their previous Medicare of Medicaid coverage to the pharmacists. Customers who don't have pressing prescription refills should wait a few days for the system to get ironed out. For beneficiaries who have to pay out of pocket for short supplies of their medication, Mr. Kocot recommends they save their receipts so they can be reimbursed once they receive their plan documentation.
Mr. Kocot added that some pharmacists may be running into problems because they're not correctly keying in information. "Frankly, they may be using the system wrong," he said.
Pharmacists say that the eligibility-checking slowdown has been exacerbated by the timing of the drug program's implementation, making pharmacies unusually chaotic over the weekend. Many employers change their insurance plans on Jan. 1, and consumers often chose the first day of the month to refill maintenance medications. Because New Year's Day fell on Sunday, many doctors' offices were closed Monday, making it harder for pharmacists to track down coverage information.
"The insurance companies are just swamped, the pharmacies are just swamped and the seniors don't understand," said Donnie Calhoun, a pharmacist and owner of Golden Springs Pharmacy in Anniston, Ala., and Quick Meds in Oxford, Ala. He says he has been getting busy signals or messages saying that call volume is too high to get through when he calls health-care providers or pharmacy benefits managers that are sponsoring the cards. He said he is giving away some prescriptions to seniors who can't pay.
Even some customers who do have cards were encountering problems. "It was pretty frustrating and aggravating," said 70-year-old Sindie Whitehead of Fruithurst, Ala., who waited two hours at an independent pharmacy on Monday only to find out that because of a problem with her card she would have to pay out of pocket for the more than $100 worth of prescriptions she was having filled. "I don't have that kind of money," says Ms. Whitehead, whose drugs were previously covered under Medicaid, the federal health program for low-income Americans.
Ms. Whitehead, who suffers from diabetes and asthma, ended up going back to her doctor and getting some free samples to carry her over until the pharmacy can process her card.
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