HEALTH CARE

Drug Plan Debacle

The Miami Herald called it an "unmitigated disaster." Gov. Tim Pawlenty (R-MN) said the "the implementation...by the federal government has been awful." "Slow, inept and dangerous," said Sen. Hillary Clinton (D-NY). Sound familiar? This time, the victims are seniors around the nation counting on the new Medicare prescription drug program. Low-income seniors and people with disabilities are still having trouble getting their medications, states are footing the bill, and the administration has responded with a PR campaign. Those affected are the frailest, sickest, and poorest Medicare beneficiaries. They include disproportionate numbers of minorities, high levels of individuals with cognitive impairment, and people who represent the most vulnerable in American society. "We expected much more of ourselves, and certainly our performance in the first two weeks was a disappointment," wrote Charles E. Hallberg, president of the prescription drug plan provider MemberHealth. "For that, I want to personally apologize to each of you." Don't expect the same from President Bush anytime soon.

THE DUAL ELIGIBLES PROBLEM: All 6.4 million low-income Medicare beneficiaries who previously received drug benefits under Medicaid, including many with disabilities, lost their coverage on January 1, 2006. (These people are called "dual eligibles.") They must now rely on Medicare Part D for their prescriptions. "To ensure that they make a seamless transition, every dual eligible who has not chosen a Medicare prescription drug plan before January 1, 2006 will be automatically enrolled to make sure that they do not lose one day of drug coverage," Medicare administrator Mark McClellan promised last year. Despite administration promises, this switch has been fraught with problems. Dual eligibles "are still having problems getting their medications, either because the health plans throw up roadblocks to approving the drugs or the patients, many of whom are on low-fixed incomes, can't afford the co-payments." To ensure the vulnerable do not go without medicine, about 20 states have had to pay for these drug claims that should have been the federal government's responsibility. Sen. Jay Rockefeller (D-WV) foresaw this problem last spring, but his bill to ease the transition for dual eligibles went nowhere in Congress.

ADMINISTRATIVE GLITCHES ABOUND: Even if a patient has enrolled in a plan that covers their drugs, delays and mistakes have kept some from receiving their prescriptions. "Problems include patients turned away because computers don't show they are covered, confusion when a patient's drug isn't covered by an insurer's plan, and the erroneous overcharging of low-income patients who qualify for program subsidies." Department of Health and Human Services Secretary Mike Leavitt suggested, "If you are one of those seniors experiencing problems, our message is don't leave the pharmacy without your drugs." This advice is hardly comforting for either patients or pharmacists. According to recent news reports, "Pharmacists spent hours on the telephone trying to reach insurance companies that administer the drug benefit under contract to Medicare."

STATES PAYING THE PRICE: Governors received more bad news this week when they learned the "federal government will not repay states that are making emergency purchases," and they will have to "recoup the money from the private plans." Some states will have to deal with "an administrative nightmare" to get the money they have spent giving "several hundred thousand" eligible recipients emergency supplies of prescription drugs. To fix the problem, a bipartisan group of senators - Olympia Snowe (R-ME), Norm Coleman (R-MN), Charles Schumer (D-NY), Frank Lautenberg (D-NJ), and Dianne Feinstein (D-CA) - introduced a bill to repay the states in full, plus interest. "While there are many problems that need to be dealt with regarding the implementation of this drug plan," Sen. Lautenberg said, "it is critical that we pay these states back as soon as possible."

BUSH'S PAVLOVIAN PR RESPONSE: Sooner than you can say "bureaucratic mess," the Bush administration sent health officials around the country "to quell rising discontent" about the problems they have had executing the benefit plan. The federal government's latest actions, Mark McClellan said, mean "all beneficiaries should be able to get their prescriptions filled." "For the majority of people who are enrolled in the drug benefit, the system's working," Leavitt said. "Seniors are continuing to enroll in large numbers." "Right now, the new Medicare Part D prescription drug program is not working as intended," said Gov. Arnold Schwarzenegger (R-CA).