While the state has bailed out low-income seniors unable to get their prescriptions filled under Medicare Part D – at a cost of $2.5 million last week – the question now is when will the federal system be fixed and how much will it cost Maine in the interim.
“We’ve put in the safety net,” said Jude Walsh, head of drug benefits in the governor’s Office of Health Policy and Finance. “No one can give me any idea when they’re going to fix this system.”
The safety net is allowing pharmacists to revert back to the old state drug plan – offered under state run Medicaid or the Drugs for the Elderly program. Pharmacists estimate that 50 percent of prescriptions were being filled last week under Medicare Part D and the rest were going through the old system.
In some cases, seniors enrolled in Medicare Part D aren’t in the national database. Others are in the system, but their income status making them eligible for discounted prices hasn’t been entered into the computer.
That means some of the state’s poorest, who were supposed to be paying between $1 and $3 in co-pays, are being asked to pay co-pays of $30, $60 or even more. Under the old system, where their drugs were being covered under Medicaid, they weren’t required to pay any co-pay if they couldn’t afford it.
“They’re going from no co-pay to telling us ‘I had to leave the pharmacy because I couldn’t afford a $100 co-pay,'” Walsh said.
Pharmacists say prescriptions that used to take minutes to fill are now taking an hour. Drug store phone lines were jammed last week as were hotlines at the state and federal level.
“Pharmacists are working harder than anybody on this,” Walsh said. “They’re on the front-lines.”
Maine was one of the first states to make a lot of noise and provide a safety net, in large part because it got actively involved in enrolling an estimated 80,000 seniors. About half of the group had been on full Medicaid because of low income and disabilities, and the other half receiving a Drugs for the Elderly (DEL) benefit provided by the state for those between 100 and 185 percent of poverty.
The low-income elderly have been the test case for the new federal system nationwide because, as of Jan. 1, the federal government cut off subsidies to state assistance plans. Those not on Medicaid have until May 15 to sign up without penalty.
In most states the federal government automatically enrolled those receiving Medicaid into Medicare Part D, but Maine reassigned thousands of them because they had been placed in drug plans that didn’t cover the medications they currently are taking. The state also attempted to enroll those receiving assistance under Drugs for the Elderly.
Whether Maine’s intervention in the enrollment process exacerbated the problem here is still a matter of speculation.
Walsh conceded the state did send names in during the final days of December, but had been told by the federal government that would not cause delays.
“The feds are on the record as saying enrollment could be as late as the 30th,” Walsh said, and there would not be a problem.
“Unfortunately, our concerns were right on the mark,” Walsh said. “We would have been happy to be wrong.”
Other states are now joining the chorus of complaints and funding drugs until the Medicare Part D problems get fixed.
Toward the end of last week, New Hampshire Gov. John Lynch announced if a Medicaid recipient’s information wasn’t in the new federal system, pharmacists should fill the prescription and bill the state. Vermont passed emergency legislation allowing the state to cover drugs for one month for about 30,000 elderly, who should have been covered by the new federal program. It could cost the state as much as $7 million.
Maine and its New England neighbors say they will get the money back somehow from the dozens of plans Medicare has contracted with to provide the Part D benefit.
“We are able to track every claim we pay,” Walsh said. The next issue is “how we’re going to recover the money.”
Bob Morrissette, director of the Pharmacy Group of New England based in Scarborough, said Maine pharmacists have been told by Walsh it could be up to them to help get the money back by reversing their claims with the state and rebilling the drug plans.
“Thirty days from now the state wants that money,” he said, but it shouldn’t be up to the druggists to collect.
“Pharmacists have more than done their job here,” he said, spending hours on the phone trying to help people with their coverage information.
“It’s still basically a mess,” Morrissette said, putting the blame squarely on the federal government. “I think people are getting their drugs, but they have to jump through 20 hoops to do that.”
Maine has about $4 million in the existing budget to cover the safety next – money it had expected to spend to subsidize or “wrap around” the Medicare Part D benefits for those formally enrolled in the Drugs for the Elderly program. The Legislature will be asked to appropriate more since Maine is paying the premiums for those they’ve enrolled and discounting co-pays and deductibles based on income.
Ironically, the state also will have to pay $12 million to the federal government for just taking over the drug benefit for Medicaid-eligible patients, because those in Washington say they can manage it more cheaply than the state has done.
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