Pharmacists and the state’s elderly began dealing with what some predicted would be a nightmare of switching over to the federal Medicare Part D drug plan as they tried to fill prescriptions using a national data base that as of last week didn’t even list most of the Mainers enrolled in the program.
“The federal government is not ready to turn this thing on,” said Jude Walsh, the head of drug benefits in the governor’s Office of Health Policy and Finance. “This is irresponsible. It’s no way to run a pharmacy benefit.”
Medicare Part D went into effect on New Year’s Day. While all Medicare-eligible seniors can sign up for the drug plan – and have until May 15 to do so without penalty – the first group to enroll were those elderly poor, who had been getting drug coverage under Medicaid or other state assistance programs like Drugs for the Elderly in Maine.
Those state programs had been serving 80,000 people and Walsh’s office helped enroll most of them in Medicare Part D since federal subsidies for state-run drug programs stopped as of Jan. 1. The problem is only 22,000 or so seniors were actually entered into the Medicare database as of last Thursday, making it tough for pharmacists to verify eligibility when customers started coming in this week to buy their drugs under the new plan.
To make matters worse, the new plan is really nine different plans – all with their own rules about what drugs are covered at what deductible and co-pay – since the federal government is contracting out this new pharmacy benefit with private insurers.
“We’re used to having one contractor, and the pharmacists are used to having one provider. Now we have nine plans in three time zones,” Walsh said. She said a special pharmacy hotline was being set up to help druggists confirm eligibility.
Wading through a myriad of plans is even tougher for those who are not being enrolled with the help of the state. More than 100,000 seniors in Maine, who had no government-subsidized drug coverage before, have to choose among 41 different plans and find the one that best fits their medical needs and ability to pay. Reports show that nationwide this group did not rush to sign up by Jan. 1, but instead will take the time between now and May 15 to decide.
Mainers who have enrolled, like most seniors across the country, have yet to receive their benefit cards under Medicare Part D, and are therefore bringing in letters to their pharmacies to verify their enrollment. Those that have forgotten their letters will be asking their pharmacists for help.
“Recipients themselves don’t know what they signed up for and don’t know what their benefit actually is,” said Joe Bruno, former House minority leader and head of the Community Pharmacy drug chain. “It’s tough for pharmacists to figure out what plan they’re in and how to bill.”
Bruno said he told his eight pharmacies to bring in extra help this week.
“It’s going to be a nightmare. I can’t imagine it being a smooth transition. There’s going to be a lot of people who are going to be so confused and not get their medication.” Bruno said.
While the federal government was ready to automatically and randomly enroll seniors who had been getting drug coverage under Medicaid, Maine opted to take over that enrollment process. The state wanted to make sure the plans they were assigned were the best fit possible for the medications they currently are taking.
The state also opted to enroll low-income seniors – making up to 185 percent of poverty – who were not on Medicaid but taking advantage of the state subsidized Drugs for the Elderly program. In order to do that the state agreed to pay their premiums, totaling more than $10 million.
Five different letters have gone out to the seniors the state has enrolled in Medicare Part D and that could add to the confusion at the pharmacy counter. Recipients flooded a state hotline with 50,000 calls over three days after the first round of notices went out and thousands of calls were still coming in daily as of last week.
Chris Gauthier, a pharmacist with Miller Drug of Bangor and president of the Maine Pharmacy Association, said he believes the state is trying to do the right thing.
“The state has screwed up quite a few things when it comes to pharmacies. This doesn’t seem to be one of them – yet,” Gauthier said.
Pharmacists have been fighting reductions in Medicaid reimbursements and most recently the state’s push toward less expensive, mail-order drugs. The state helped the Penobscot Indian Nation set up a mail-order business on Indian Island last year, with $900,000 in combined state and federal economic development grants, and consulting from the governor’s Office of Health Policy and Finance. Mail order, the pharmacists argue, will put them out of business.
As for coping with Medicare Part D, Gauthier said: “We’re about as a ready as we think we can be. Ask me Feb. 1.”
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