Government

Prescriptions go unfilled as Medicare D sees rocky start

Doctors and pharmacists are overwhelmed by technical and bureaucratic problems in the opening days of the Medicare drug benefit.

By David Glendinning — Posted Feb. 6, 2006

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Washington -- Robert E. Sager, MD, last month wrote some of his senior patients prescriptions they could fill using the new Medicare drug benefit, but several came back empty-handed.

The multitude of problems that have accompanied the Jan. 1 launch of Medicare Part D has affected the small town of Liberal, Kan., where Dr. Sager runs a solo family practice. Technical glitches and breakdowns in communication erased any hope that the start of the drug benefit would be a smooth affair, he said.

"The patients are finding that they're not in the computer yet, so the pharmacy won't give them the drugs because it can't get paid," he said. "The two pharmacies that operate here are both fed up with the paperwork, and they can't get through on the phones with the insurance companies to clarify anything."

As a result, some seniors and people with disabilities who couldn't afford to buy their medications without help found themselves at odds with the private insurance plans that the government entrusted to administer the benefit. A number of them gave up and went home before they resolved the situation.

Unfortunately for physicians, pharmacists and Medicare patients across the nation, Dr. Sager's story is not unique. Federal health officials said that tens of thousands of drug plan enrollees reported difficulties filling their first prescriptions under the new benefit during the first two weeks of operation.

If chronically ill patients begin to fall off their required drug regimens because of the problems, doctors worry they soon will start to see adverse health effects. Diabetics, patients with heart conditions and people with mental illness are at particular risk for serious health consequences, they said.

In many cases, these concerns center on the poorest and sickest patients who are eligible for Medicare but who previously received all of their drugs through Medicaid.

With the transition of all of these "dual-eligibles" over to the Medicare benefit, many were unable to fill their prescriptions when they found that their enrollment information was missing or that the system was inappropriately charging them deductibles or co-payments that they couldn't afford.

"The difficulty in transitioning from Medicaid to Medicare for prescription drugs is having a major impact on our patients with severe and persistent mental illnesses," said Steven S. Sharfstein, MD, the American Psychiatric Assn.'s president. "Relapse, re-hospitalization and disruption of essential treatment are some of the consequences of this bureaucratic nightmare."

As the federal government and Medicare drug plans scrambled to fix the widespread problems, physician groups such as the American Medical Association urged their members to stay diligent to minimize any clinical fallout that could occur.

"The AMA is concerned about the health consequences for patients who have not received needed medications in the first few weeks of the Medicare prescription drug program," said AMA President J. Edward Hill, MD. "Many of the affected patients are our most needy ... and it's important for physicians to keep a close watch on patients who may have gone without medications."

Dr. Sager said he hadn't yet seen any adverse health effects in seniors who stopped taking their drugs. Such cases might not appear until later this month, when patients start running out of any leftover drugs they may have from last year, he said.

States of emergency

Some states weren't waiting for Medicare officials to work out the kinks. Nearly two dozen states and the District of Columbia announced that they would temporarily keep paying for the drugs that previously were covered under Medicaid. Some of the states' health officials went so far as to declare public health emergencies and to say that the federal delivery system had broken down.

The move is likely to spark a fight on Capitol Hill over who will end up paying the bills. Already, several bipartisan groups of lawmakers have introduced legislation that would reimburse states for what they spend on Medicare drugs in the interim.

Medicare officials moved quickly to quell the public outcry. They said the errors were temporary and called for calm. Despite the publicized breakdowns, most seniors were finding that the system was working well, and the rest would see smoother sailing once they were able to fill their first prescription, Dept. of Health and Human Services Secretary Michael Leavitt told reporters on a conference call.

"We're committed to fix every problem as quickly as possible, and we'll do it as long as it takes, though we expect every day we'll see improvements," he said. "Adding a prescription drug benefit to Medicare is the biggest change in this program in 40 years, and it's happening all at once. When millions are enrolled all at the same time, there are bound to be some transition problems."

Leavitt and Centers for Medicare & Medicaid Services Administrator Mark McClellan, MD, PhD, said the administration had helped resolve many of the initial technical problems that caused the transmission of incorrect or incomplete information to pharmacies. In addition, plans are responsible for providing a 30-day emergency supply of drugs to any beneficiary whose coverage details are in doubt, as well as for reimbursing states and beneficiaries that have fronted the money for costs that are insurers' responsibility, they said.

But even if the federal government gets the entire program into working order right away, that doesn't mean the end of coverage headaches for some seniors and their doctors. Dr. Sager said he would need to come up with viable clinical alternatives for several expensive diabetes and pain medications that will not be covered to the same extent under the Medicare benefit as they were under other types of coverage.

Doctors also can expect to spend more time on the phone with pharmacists if plans are forcing beneficiaries to switch to generics or to obtain prior authorization before filling certain prescriptions, he said.

Back to top


ADDITIONAL INFORMATION

Progress amid problems

Despite technical errors, federal officials report strong enrollments in the Medicare drug benefit. More than 2.5 million seniors signed up for a stand-alone plan between mid-December and mid-January. Here's how the overall figures broke down as of Jan. 13.

Retiree coverage with
Medicare subsidy
6.4 million
Automatic transfers
from Medicaid
6.2 million
Medicare Advantage plans 4.5 million
Stand-alone prescription
drug plans
3.6 million
Military/federal worker
retiree coverage
3.1 million
Total 23.8 million

Source: Centers for Medicare & Medicaid Services

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn