Action by state fails to fix drug plan woes
Some seniors still refused pills amid Medicare confusion
A day after state health officials took emergency action to ensure senior citizens are not denied medications because of confusion surrounding the new federal Medicare drug benefit, there are reports that some are still leaving pharmacies empty-handed.
Secretary of Elder Affairs Jennifer Carey yesterday said the state would temporarily foot drug bills for participants in the state's Prescription Advantage program, even if pharmacists cannot verify coverage. Prescription Advantage provides drug subsidies to about 72,000 Massachusetts residents.
''Until we see the new benefit is operating smoothly, we'll be picking up the full cost of the drug, as we did before Jan. 1," Carey said. ''This will go a long way to smoothing the path for elders to get their prescriptions."
Carey said Prescription Advantage has been receiving 1,500 calls a day from customers since late last week. An additional 300 calls daily are being received by the Elder Affairs office. Because of the new plan's complexities, each call has been taking an average of 13 minutes, she said.
On Jan. 1, a new Medicare benefit, known as Part D, went into effect. It provides expanded coverage for prescription drugs for senior citizens, administered through private insurers. With the new federal benefit, the role of Prescription Advantage was supposed to change: Instead of paying for drugs or copayments, as it has traditionally done, its purpose is to fill gaps in the new Medicare drug coverage. But the change has been put on hold.
On Monday, the state Medicaid Program, MassHealth, ordered pharmacists to fill prescriptions and bill the state if they are unable to verify a customer's insurance coverage. Other states, including several in New England, have taken similar steps.
But George Sigel, a psychiatrist at South Boston Behavior Health Clinic, part of Tufts-New England Medical Center, said his patients are still being denied essential medications. He said one patient has been unable to get his prescribed antipsychotic medications at a CVS Pharmacy on West Broadway in South Boston.
''We are not talking about medication that's for the treatment of minor symptoms," said Sigel. ''These are life-supporting medications. The pharmacies are not doing what they're supposed to do and I have patients in tears."
Mike DeAngelis, a spokesman for CVS Corp. of Woonsocket, R.I., the nation's largest chain of drug stores, said pharmacists have been instructed to provide a temporary supply of medications to patients even if there are administrative glitches.
''No patient should be walking away without medication if there's a problem getting their Part D coverage verified," said DeAngelis. ''We will follow up with these stores to ensure they're complying."
Ruth Bylsma, 62, of Norton, said she suffers from arthritis of the back and a herniated disc and has been unable to get pain medication since Part D took effect. Because she received her drugs through Medicaid, Bylsma was randomly assigned to a Medicare plan when Part D took effect Jan. 1. Her doctor's office needs to contact her new insurance company to confirm her enrollment, but has been unable to get through on a customer-service line.
''It's been eight days and I'm in pain," she said. ''I've done everything. This is crazy."
The introduction of the drug plan has hit numerous snags. Some seniors don't yet have documentation to prove they have coverage, pharmacists have been unable to contact insurance companies because help lines are clogged with calls, and Medicare's web tools have provided incomplete or inconsistent information.
The problems come on top of the confusion seniors and caregivers have endured while trying to decipher the plan and choose from more than 40 options in Massachusetts. Some lawmakers have asked for a postponement of the May 15 deadline for seniors to choose a drug plan. Those who sign up later risk facing penalties.
Melissa Shannon, a policy coordinator at Health Care for All, said, ''There's all sorts of misunderstandings out there." The nonprofit advocacy group has fielded complaints from across the state. ''This problem is not going to go away in two weeks," she said.
Jeffrey Krasner can be reached at krasner@globe.com. 