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Medicare Rx Glitches a Pain for Many

Thousands Denied Rx Drugs in Program's Early Days

WebMD Health News

Jan. 17, 2006 -- Federal officials defended their implementation of the new Medicare prescription drug benefit Tuesday after reports that some beneficiaries have been unable to get promised medications in the program's first month.

Health officials said they are asking insurance companies administering the benefit to give more help to pharmacists filling prescriptions for seniors using the benefit. They also said the government is boosting the number of caseworkers assigned to help beneficiaries obtain medicines.

The move comes after reports of database problems that have caused tens of thousands of mostly poor beneficiaries to go without prescriptions. More than 20 states have reported significant problems, and several -- including California and New York -- have begun providing emergency medication supplies to patients who could not pay for drugs once they were denied by Medicare at the pharmacy.

Bush administration officials acknowledged the difficulties but said that overall the implementation of the new "Part D" drug benefit -- the largest change in Medicare's 40-year history -- has gone smoothly. At the same time, the officials said they expect some of the problems to continue.

"When millions are enrolled all at the same time there are bound to be transition problems," Secretary of Health and Human Services Michael O. Leavitt told reporters Tuesday. Leavitt warned that access difficulties could persist as more Medicare beneficiaries come to pharmacies to use Medicare prescription drug cards for the first time.

"We're likely to see these problems on an ongoing basis until everyone has used their card once," he said.

Most reported problems have affected patients who had received drugs through the Medicaid insurance program for the poor. As of Jan. 1, those patients, who number 6.2 million, were to begin receiving prescriptions through the Medicare benefit instead.

But many reports over the past weeks indicate that thousands of those seniors have been turned away at pharmacy counters because their names did not appear in drug plan databases.

Too Little, Too Late?

Robert Hayes, executive director of the Medicare Rights Center, an advocacy group that has criticized the drug plan, said pharmacists have reported not being able to get through to health plan operators and that available operators "often don't have a clue" about how to solve problems of missing patient names.

"A belated edict from Washington for more phone operators is not going to solve that," he told WebMD.

Spokeswoman Deanne Beebe said the group has received reports of chronically ill patients who ran out of medications when pharmacies would not fill prescriptions. They include one Medicaid recipient in New York City who went two weeks without drugs for kidney failure. "She only got them now because of New York State stepping in," she said.

Federal officials said they had ordered a review of Medicare's beneficiary database and were asking insurance plans to cross-check their own computer systems to help find missing names. States are also set to begin seeking repayment for millions of dollars in emergency drug supplies given out to seniors.

Medicare Administrator Mark McClellan, MD, said it was "unacceptable" that some beneficiaries are unable to secure covered drugs. He said that pharmacists are already filling 1 million prescriptions per day under the new program, though some of the seniors receiving those drugs already had drug coverage through an employer before the Medicare plan began.

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