Medicare Situation Still Chaotic

With only one kidney, Francisco Villasenor depends on dialysis and a special drug to cleanse impurities from his body.

But on Friday, he left the Rite Aid pharmacy in Los Feliz without the drug. He didn’t have $179 the drugstore demanded.

“How can I pay? I don’t have money,” said Villasenor, 47, lifting his sagging polo shirt to show the L-shaped scar where surgeons removed his left kidney five years ago when his organs began to fail.

Until two weeks ago, he got his medication for free. Then the federal government automatically switched about 6 million elderly and disabled Americans such as him -- 1 million just in California -- into the new Medicare prescription drug program, and the glitches began.

Since Jan. 1, countless low-income Medicare patients have been turned away from druggists’ counters or forced to come up with large sums of cash for crucial drugs.

Despite emergency measures announced Thursday by California officials to cover the costs of drugs for this group in the short term, relatively few patients were able to take advantage of the move Friday. Many didn’t know about it.

Indeed, hundreds of pharmacies -- including stores operated by at least two major chains, Long’s and Rite Aid -- apparently hadn’t received word of the last-minute guarantees by the state and were charging regular prices for the drugs.

Some people went away empty-handed; others dependent on vital drugs such as insulin dipped deep into limited savings or borrowed from others. Still others made tough choices, forgoing asthma medication, for example, for blood pressure pills.

Even when glitches in the new drug plan were resolved thanks to the emergency measures, many seniors were overwhelmed by new co-payments they didn’t realize they would have to pay.

The sums sound small enough -- $1 to $5 per prescription. But they can add up to a lot for many seniors taking 10 or more medications per day.

Advocates for the elderly said their offices continued to be deluged with calls from bewildered and frustrated low-income Medicare recipients.

“You can hear the level of frustration in people’s voices -- particularly when they reach an actual person speaking rather than a machine,” said Margaret Reilly, program manager for the Northern California branch of the Health Insurance Counseling and Advocacy Program. “People are at wits’ end.” Her agency, with offices around the state, advises beneficiaries of Medicare, the federal program for the elderly and disabled.

Cheryl Meronk, the agency’s Orange County program manager, says it has gotten so bad that they were recommending that clients turned away at a pharmacy seek treatment and drugs in emergency rooms because the visits would be paid for by Medicare.

On Friday, Sen. Dianne Feinstein, one of the few Democrats to vote for the prescription drug plan pushed by President Bush in 2003, described the program’s faulty debut in dire terms.

“The result is a major health emergency in California, particularly for people with chronic and debilitating diseases who rely on multiple medications daily to keep them alive,” she wrote.

Several other states -- including Ohio, Wisconsin, Illinois, Pennsylvania, New Jersey, North Dakota, South Dakota and all those in New England -- said they also would cover drug costs for low-income seniors.

Schwarzenegger called on the federal Health and Human Services Department “to reimburse California taxpayers for the cost of this providing emergency temporary emergency coverage to its most vulnerable residents.”

Most affected are the 1 million elderly and disabled Californians who qualify for the state’s health insurance for the poor, known as Medi-Cal, which had covered prescription medicines in full until Dec. 31. Now Medicare, the federal government’s health insurance for the elderly and disabled, has taken over coverage.

The former Medi-Cal recipients were told they would not be charged the standard $250 deductible and co-payments.

Last fall, they and other Medicare recipients were asked to choose from among a dizzying array of replacement drug plans offered by private companies, with varying deductibles and coverage. The plans were tough for even well-educated elder-law attorneys and senior advocates to slog through, not to mention the poor and elderly, including some suffering from dementia or living in nursing homes.

If they didn’t indicate a choice by Dec. 31, Medicare was to assign them a plan.

But when many of these people showed up at drugstores, there was no record of the new coverage, or the records were wrong. Pharmacists demanded full price for the drugs.

Pharmacies were equally confused. At Beyond the Pharmacy in Silver Lake, technician Willy Mesta said since the new rules took effect Jan. 1, confusion has been the one constant among his store’s regular customers.

“It’s a hassle,” he said, noting that some of his customers just walk away to avoid paying.

Even those whose coverage is intact have a tough time parting with the new $1, $3 and $5 co-payments, he said.

“Sometimes they argue with it, ‘Why do I have to pay now?’ We have to explain it to them. ‘Didn’t you get a letter in the mail?’ ” Mesta said Friday. “It may not seem like a lot -- one or two dollars -- but the reimbursement we’re getting is not a lot either.”

Jody Cook, spokesman for nationwide Rite Aid Corp. stores, said: “We’ve told our pharmacists to use their professional discretion to make sure each patient gets the prescriptions they need.”

She said she couldn’t comment on whatever state order was handed down in California because she was unaware of it.

The stress of it all has taken a heavy toll on people suffering from chronic diseases.

Henry Cook, 52, of Los Angeles, who has had diabetes since age 6 and was disabled by complications of an aneurysm, chokes up as he talks about what happened to him.

The Rite Aid drugstore he has patronized for years told him he owed $250 because his deductible hadn’t been covered to pay for insulin and related supplies. He opted to forgo his blood pressure medicine, but still had to borrow money. By the time he got home to measure his blood sugar, it had soared.

He has since resolved some of the problems after spending hours on the phone.

“What’s worrisome is that any time I’m going to have to get the prescriptions refilled, I’m going to be sweating bullets because I’ll never know what to expect,” Cook said.