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Seniors Slam Medicare Coverage: Thousands of seniors have had trouble getting prescriptions filled by their Part D Medicare Coverage

Ruth Kelton Feb 7, 2006

They lost me!” wailed Sherawn. In early January she was seated in a small clinic on the Lower East Side. “When I went to get my meds at the store, the pharmacist couldn’t find me on the computer.”

Sherawn, a Medicare/Medicaid “dual-eligible” patient, was one of thousands of seniors who, since Jan. 1, have had trouble getting prescriptions filled using their new Part D Medicare Prescription Drug coverage. Other seniors have had similar problems.

Victor, sitting in the crowded anteroom of a Manhattan diagnostic lab, groused, “I couldn’t get my medications. They said the insurance company Medicaid assigned me to didn’t cover them.”

And Gillian, a Medicare patient at the Lower East Side clinic, said she hadn’t even signed up for Part D yet and so had no drug coverage. “Too confusing! The rules are too complicated and there are just too many insurance plans.”

Seniors calling the Medicare helpline are likely to have a long wait for an answer. (A recent caller was faced first with a nearly impenetrable menu of choices, followed by nearly half an hour on hold before reaching an operator.)

Pharmacists complain that reaching the private insurers handling Part D is impossible: “They just don’t answer,” says one professional trying to help a customer.

Part D, ostensibly set up to make both generic and patented prescription drugs cheaply and easily available to the old and the poor, seems to have morphed into a monster designed to frustrate and confuse many of the people it was supposed to help:

• A recent AP-Ipsos poll found that two-thirds of the seniors surveyed thought the plan was hard to understand.

• In New York State alone, a partial list of insurers from which Medicare and dual-eligibles must choose to get Part D includes 150 insurer-administered Health Management Organizations (HMOs) and private Prescription Drug Plans.

• Each of the thousands of such plans available across the country offers a different list of drugs it will cover.

To help beleaguered Part D participants and those trying to enroll, advocacy groups have begun “an immediate, if piecemeal, effort to remedy the problems facing seniors,” says Deane Beebe, communications director of the
Medicare Rights Center in New York City.

Barbara Cebuha, a spokesperson for the Centers for Medicare Services (CMS), the government’s Medicare coordination arm, estimates about 10,000 people may have been adversely affected. CMS has increased its staff of caseworkers to 4,500 to handle the increased volume of queries, and according to Cebuha, “millions of prescriptions have been filled.”
Her outlook may be a little too sunny. Many advocacy groups estimate that the number of seniors snarled in Part D problems runs to the tens of thousands.

For immediate help at the cash register, about half of the states have stepped in with state funds to cover seniors’ costs. A group of Democratic senators has introduced a bill mandating federal reimbursement to the states for their fielding of federal responsibilities. And CMS has outlined a program for state reimbursement.

The source of all these problems lies, of course, in the present administration’s privatization of public services. The Medicare Prescription Drug Improvement and Modernization Act of 2003, the foundation of Part D, was essentially a direct handout to private industry.

John Steinberg, a spokesman for Sen. Harry Reid (D-Nev.), one of the act’s strongest opponents, says: “The bill was designed by and for the special interests. The drug industry and HMO lobbyists helped write it to protect their interests, while seniors’ interests were not protected.”