ADV-NEWS, Renewed Worries on Medicare Drug Plans

http://www.nytimes.com/2006/12/05/wa...th&oref=slogin

Renewed Worries on Medicare Drug Plans

By ROBERT PEAR
Published: December 5, 2006

WASHINGTON, Dec. 4 - Pharmacists and advocates for older Americans say
they are worried that tens of thousands of low-income Medicare
beneficiaries will again have trouble getting medications next month,
as they did in January of this year.

Many prescription drug plans are changing benefits. Beneficiaries are
changing from one plan to another. New plans are entering the market.
Some beneficiaries will find they can no longer use the drugstores
they have been using.

"There will be surprises and shocks for some beneficiaries," said
Michael J. Negrete, vice president of the California Pharmacists
Association.

About 600,000 poor people are losing the guarantee of extra assistance
that covered nearly all their drug costs this year.

"Starting Jan. 1, 2007, you will no longer automatically qualify for
this extra help," the Bush administration said in letters sent
recently to these beneficiaries.

Some may still be able to obtain extra help. But they need to apply to
a federal or state agency, and few have done so.

Pharmacists and insurance counselors say many of the 600,000
beneficiaries will not discover the change in their status until they
show up at pharmacies next month. Then they could be charged $25 to
$50 or more for drugs that cost them only $3 or $5 this year.

Druggists say they also foresee problems for another group: 300,000
low-income people who will be reassigned to plans chosen at random by
the federal government.

Even people who stay in the same plan may face surprises because some
of their drugs may no longer be covered. Plans can change the list of
covered drugs from one year to the next, dropping some and adding
others.

Mark J. Gregory, a vice president of Kerr Drug, which owns 102
pharmacies in North and South Carolina, predicted some snarls and
delays for customers next month, but said, "It can't be as bad as
early this year."

"Some seniors will show up at the pharmacy, unaware they have been
reassigned to a different plan," Mr. Gregory said. "They may find that
the new plan no longer covers some of their medications. Others may
learn that they no longer have a low-income subsidy, and they cannot
afford the new co-payment. In both cases, drug therapy may be
interrupted."

Mr. Gregory offered this advice: "Beneficiaries should be prepared. If
you have any doubt, take action now. Ask questions. Call your plan.
Don't wait till Jan. 1."

Jennifer Mezey, a lawyer at the Legal Aid Society of the District of
Columbia, voiced a similar concern. "Come Jan. 1," she said, "some
low-income people will show up at the pharmacy and be charged full
price, and they won't be able to get their medications."

Even if a drug is still covered, Ms. Mezey said, it may be subject to
new restrictions limiting the number of pills or requiring doctors to
get advance approval for prescriptions.

Federal officials said they were trying hard to avoid a repetition of
the problems that overwhelmed pharmacists 11 months ago.

With a year's experience, they said, pharmacists, insurers and
beneficiaries know what to expect. Medicare has upgraded its computer
systems. Insurers have hired more people for telephone call centers.

"Lessons have been learned," said Kathleen M. Harrington, a
spokeswoman for the Medicare agency.

Beneficiaries have until Dec. 31 to pick a plan. The Bush
administration is urging people to act by this Friday, to avoid delays
on Jan. 1.

E. Timothy Marks, co-owner of Excel Drug, a pharmacy in Waldport,
Ore., said beneficiaries should be prepared for "problems somewhat
similar" to those they experienced early this year.

"The plans are too complicated for some of the elderly to understand,"
Mr. Marks said. "Many low-income beneficiaries eligible for Medicare
and Medicaid are unaware of the procedures and changes that will
affect their drug coverage."

In the chaotic first weeks of the drug benefit this year, many
pharmacists gave away drugs, and many states established emergency
assistance programs for low-income people who could not get the drug
coverage promised by Medicare. New York and other states have
curtailed those programs.

William P. Scheer, chairman of the Pharmacists Society of the State of
New York, who owns a drugstore in the Bronx, said: "Some people will
go cold turkey on Jan. 1. They will go without needed medications that
they have been receiving under the state program."

The New York State Health Department is sending a "reduction of
benefits notice" to people who receive both Medicare and Medicaid. It
says the state will no longer cover their drugs, with a few
exceptions.

New York officials are urging doctors to help patients get coverage
through Medicare. Doctors could, for example, rewrite prescriptions or
ask Medicare to make an exception for a particular drug and a
particular patient.

California is continuing its emergency program through Jan. 31.

"We anticipated that there could be problems in January," said Stan
Rosenstein, the Medicaid director in California. "So we kept the
program available as a safety net. The governor and the State
Legislature did not want any possibility of disruption."

Mr. Rosenstein said he was most concerned about 85,000 Californians
who were losing automatic eligibility for Medicare's low-income
subsidy. "It could be a surprise when they go from paying $5
co-payments to having a $250 deductible," he said.

The Bush administration has repeatedly advised beneficiaries that they
do not have to take any action if they are satisfied with their
current drug coverage.

But insurance counselors and health care lawyers say most people can
save money by switching plans in 2007.

Katrina A. Eversole, an insurance counselor at the Washington County
Commission on Aging in Hagerstown, Md., said she had helped 50
beneficiaries in the last week.

"In most cases," Ms. Eversole said, "we are signing them up for new
plans and saving them a great deal of money. We can often find a plan
whose total annual costs will be just half of what they would have to
pay for their current plan in 2007."