The launch of the new Medicare Part D drug program in early January came as a shock to millions of the nation's sickest and poorest seniors and disabled.  Hundreds of thousands had to pay far more than anticipated for their prescriptions or leave their pharmacies empty-handed.  

The bulk of the problems affected some 6 million "dual eligibles," Medicare beneficiaries whose incomes are so low that they also qualify for Medicaid.  Most of the dual eligible beneficiaries didn't choose their drug plans.  Instead under federal law, they were assigned at random to new Medicare Part D drug plans, effective January 1, 2006. 

According to media accounts, as many as 20% of the low-income Medicare beneficiaries were still going without their prescriptions after more than two weeks.  Tens of thousands were assigned to plans inappropriate for their needs. The federal government doesn't require drug plans to cover every drug.  Many learned that their drug plan did not cover all their prescriptions.  Although rules allow beneficiaries to switch plans if this happens, that may take several months. 

Numerous other factors also contributed to the chaos. Many people did not bring or had not received their drug plan I.D. card or proof of coverage.  Medicare's and drug insurers' call centers were overwhelmed.  Pharmacists found that the Medicare database was riddled with errors concerning eligibility and co-payments.  Medicare officials admitted to a pharmaceutical error rate as high as 90 percent in the first couple of days of the program.

In December of last year the government announced contingency plans to ensure that dual eligibles would not lose coverage.  "They'll be able to leave the pharmacy with their prescription in hand, even if there is not immediate evidence of what plan they're in," CMS Administrator Mark McClellan said.  But the contingency plans failed.

Under the rules, every drug insurer must provide a temporary supply, typically 30 days, of any prescription that a person was previously taking.  However, The New York Times reported that during the first week of the program customer service representatives at Medicare's toll free number said they knew nothing about the requirement and beneficiaries said it was virtually impossible to take advantage of it.

More than 24 states and Washington D.C. took emergency action to ensure their residents got promised drugs.  TSCL believes this will undoubtedly add to growing state friction over the new Medicare drug benefit.  By law, states must pay the federal government to provide the new drug benefit for their former Medicaid recipients. 

TSCL feels the complexity of the new prescription program is proving totally unworkable and an obstruction to seniors receiving the benefit that Congress promised. TSCL is urging Congress to fix the problems and supports legislation that would extend the Part D enrollment date from May 15, 2006 through the end of 2006, waiving the penalty for late enrollment.  TSCL is anxious to hear from our readers about your experiences with Medicare Part D and what you think about the program.  We want to voice your concerns in our upcoming meetings on Capitol Hill.

Sources:  "Ensuring An Effective Transition of Dual Eligibles," CMS, December 1, 2005.  "Medicare Coverage Problems Persist," Josie Huang, Portland Press Herald, January 8, 2006.  "States Intervene After Drug Plan Hits Early Snags," Robert Pear, The New York Times, January 8, 2006.  "State Steps In To Help Seniors Get Medicines," Victoria Colliver, San Francisco Chronicle, January 13, 2006. 

March 2006