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Glitch Adds to Medicare Drug Plan Confusion

I have a confession to make.

I was defeated by the new Medicare drug program.

The weapon used against me was Medicare’s “plan finder,” a website that churns out a list of private Medicare drug plans, along with their estimated annual costs, based on the prescriptions the user types in. The website then prompts the user to enroll in the plan that best suits his or her medical and financial profile.

Unfortunately, the system is burdened by numerous peculiarities and complexities that render it almost useless for millions of potential beneficiaries. The most serious drawback is the one that snagged me: While the program bases its calculations of prescription costs on a “30-day supply” of each drug, for those taken orally it assumes that a 30-day supply is 30 pills.

But many medications aren’t taken once a day. Unless the user manually overrides the 30-pill default, the result can be wildly misleading.

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When I tested the system for a column last month, I typed in Actonel, an osteoporosis drug commonly prescribed for patients over 65. Actonel is taken once a week. Therefore, the 30-pill default overestimated its monthly cost sevenfold, hopelessly contaminating the results. How hopelessly? Of the 48 health plans available to California residents, the one it ranked as the least expensive was really the 37th most expensive when the correct dosage was entered. Any unassuming or inexperienced customer therefore risked being steered to the wrong plan.

This glitch isn’t exactly a secret. Medicare authorities were alerted to it in November by drug manufacturers concerned that it could make their products seem unaffordable. (The error also understates the cost of a medication taken several times a day, such as many diabetes treatments. That could steer beneficiaries to the wrong plans, too.) In response, Medicare’s web designers added a note prompting users to double-check the quantities of their pills when entering prescriptions. But the notice can be easily overlooked amid all the other verbiage cluttering the screen -- especially by people navigating the system for the first time.

Such confusion could have been avoided had the proper quantities been plugged into the website’s database from the start. Mary Agnes Laureno, who oversees the website as director of beneficiary information services at the government’s Centers for Medicare and Medicaid Services, says her staff is revising the pill quantities in the database, but the job may not be done until this summer. In other words, the flaws are likely to persist through this year’s enrollment deadline of May 15.

Laureno’s sincere efforts notwithstanding, it still isn’t clear that Medicare officials understand how thoroughly confusing their showcase product is. At a recent Kaiser Family Foundation forum analyzing the drug program’s disastrous launch, Deputy Medicare Administrator Leslie Norwalk portrayed the website as a roaring success. Of the 3.5 million seniors who had signed up for the benefit voluntarily, she said, 1.5 million had done so online.

“In spite of the concerns we heard that people don’t use it, apparently many do,” Norwalk said, triumphantly. But should she feel vindicated? Her figures show that barely 43% of enrollees registered online, including those with help from caregivers and professionals; considering that the website is designed to be the prime source of objective information for eligible seniors, that record seems more shameful than sterling.

Then again, the Bush administration’s response to the drug program fiasco, which has led 31 states to offer emergency assistance to seniors caught in the muddle, is tilted heavily toward PR. Typical of its approach is a “one month progress report” issued Feb. 1 by Health and Human Services Secretary Mike Leavitt.

After a pro forma acknowledgment of “unexpected problems” with the Medicare drug benefit, Leavitt writes: “I make no excuses.”

He then proceeds to blame the problems on seniors who confused data processors by waiting until the end of the month to enroll in or switch health plans; Medicare and insurance company computers for not knowing how to communicate with one another; and the health plans themselves for not having enough staff on hand to answer calls. Leavitt doesn’t mention that Medicare itself assigned only 150 phone representatives to assist pharmacists during the program’s rollout in January, despite indications that at least 4,500 were needed.

Leavitt’s report brims with assurances that conditions are rapidly improving. But that’s not uniformly apparent on the ground. “We know there are still many, many people going home without their prescriptions,” Jeanne Finberg, directing attorney for the National Senior Citizens Law Center in Oakland, told me this week. Among other problems, pharmacists are still forced to maneuver through a multitude of plans with different rules, drug prices and procedures while customers stand in line.

As always, the weakest suffer most. “It’s the survival of the fittest,” Finberg says. “Some people are assertive enough or healthy enough to get what they need. People who are not hearty or are timid just give up.”

Meanwhile, Leavitt offers anodyne assurances that his staff is doing its darndest. “The measure of our success should not be that we had no unexpected problems at the outset,” he wrote, “but rather that we were able to find, fix and finish the unexpected problems quickly.”

Two comments on that: First, with two years of preparation, there’s no excuse for so many “unexpected problems” in the first place. Second, the fundamental flaws in the program, including its potential for manipulation by the health insurance and drug industries, remain unaddressed. Until that changes, the confusion and suffering will continue.

Golden State appears every Monday and Thursday. You can reach Michael Hiltzik at golden.state@latimes.com and view his weblog at latimes.com/goldenstateblog.


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