Drug Plan Chaos -- Is It Cured?

Joan Steggell fumed at the pharmacy counter.

“This is a mess,” she bellowed at no one in particular. “We need the medicine!”

For two days running, Steggell, 48, had run into delays trying to get critical medication for her husband that prevents him from having seizures. Whenever the store, Med-Rx Drug, tried to process his claim, his drug plan refused payment.

The couple, both disabled from a car accident three years ago, had eagerly anticipated the new Medicare prescription drug plan. They thought it would bring financial relief.

Instead, it has brought anguish.

“It’s like my [prescription drug] card is just paper,” said Steggell’s husband, Alan Sheridan, 58.

For three weeks, such problems have rankled Medicare beneficiaries -- most of them low-income people -- across the country. The new prescription drug benefit’s disastrous launch has resulted in thousands of snafus that, in many cases, have kept elderly or disabled poor people from getting their drugs or forced them to pay significant costs out of pocket.

It was supposed to be a signature program for the Bush administration, bringing cheaper prescription drugs to millions of Medicare beneficiaries. But problems immediately became apparent after Jan. 1, as 6 million low-income beneficiaries on Medicaid -- 1 million of them in California -- were rapidly transferred to the Medicare drug program, which is operated through a number of private insurers. Computer databases used to verify eligibility were not ready, and when they became available, they were plagued with errors.

More than 20 states, including California, stepped in to guarantee payments to pharmacies so prescriptions could be filled.

Now, top Medicare officials say the worst is over. Every day, they say, the plan works better.

A day spent at a neighborhood pharmacy in this city of 135,000, where the druggists and clerks know many longtime customers by name, shed some light on what works and what still needs working out.

No Medicare beneficiaries at Med-Rx walked away without medications that they needed immediately. The store gave patients a limited supply of such drugs until billing could be resolved -- an approach that some grateful patrons said was not embraced by chain pharmacies they had tried.

Most of the roughly 40 Medicare patients who came this day did not encounter significant problems. Three of every four prescriptions for these elderly or disabled patients were processed as expected.

Steggell, for instance, was able to get her own medication for high blood pressure a day earlier without difficulty. So was her mother, 81, for a heart condition and diabetes. Even Sheridan got his full prescription, after the pharmacist agreed to process the claim later.

Dominic Ciolino, 56, was in and out of the drugstore in a few minutes’ time.

His mother, who had been receiving drugs through Medi-Cal, the government healthcare plan for the poor, was automatically assigned to a new private plan that covered all the drugs she needed.

“It was so smooth I don’t know what plan she’s on,” Ciolino said.

Not so for Wilma Juker, a waitress, who spent at least 20 minutes Friday morning anxiously staring at a store shelf, waiting to hear if her prescription would go through.

Juker had awakened that morning with plugged-up lungs. She could hardly breathe. Her doctor had sent her to the drugstore to get a medicine to prevent a relapse of pneumonia, which she had suffered over Thanksgiving.

“This will be my first try,” she said. “I’m 70. I work five days a week. I’m lucky to keep going.”

“It’s really scary,” Juker said, with a slight rasp in her voice. Other than Medi-Cal and Medicare, she said, “I have no health plan. No nothing.”

Her new prescription drug card didn’t go through -- the computer couldn’t connect to her new private plan under Medicare. But a pharmacist gave her three days’ worth of pills to get her through the weekend, assuring her that they would try to resolve the issue today.

Paulette Bryson, 55, whose daughter is recovering from back surgery, said the rocky drug plan start-up was particularly difficult for seriously ill people who require a dozen or more medications.

“It has been a nightmare,” Bryson said.

She had expected significant savings with the new Medicare plan and had chosen a plan for her daughter that would give discounts on drugs for which, until now, she has had to pay full price. She and her husband spent $25,000 on medication last year for their 32-year-old daughter, who suffers from severe osteoporosis.

But she’s been disappointed. The day before, Bryson had gone to another pharmacy and ended up paying $162 for a medication her daughter needed to quell nausea. The pharmacist had told her it wasn’t covered. She disputed this but was forced to pay full price.

“If you have to have the medicine, you have to have it,” Bryson said.

Bryson encountered another problem: She had to rush her daughter back to the UC San Diego hospital Friday because her new Medicare insurer had denied payment for an intravenous antibiotic, which was ordered through another pharmacy. Her daughter is combating a blood and spine infection.

“The government rushed into this,” Bryson said, “and now the consumers are paying the price.”

She did have one success: She was able to pick up one other drug for her daughter at Med-Rx through the plan without a hitch.

Employees at the 30-year-old pharmacy did their best to resolve snags. Pharmacist John Olmstead, Med-Rx’s president, said he had had to staff an additional pharmacist and technician just to help guide customers on how to select a Medicare plan, raising his operating cost 10%.

For weeks, he said, staffers have sometimes spent hours at a time helping customers. For instance, some Medi-Cal beneficiaries have been automatically placed in plans that don’t cover a drug they’ve been taking for years.

In those cases, pharmacists are the go-betweens for patients, doctors and insurers -- a taxing role that can eat up huge chunks of time, he said.

“This is the largest transfer of one group of people into a managed prescription system,” he said. “It just comes with the territory. We were going to have problems.”

It could take at least three months until the system flows smoothly, Olmstead predicted.

“Give it time to settle down,” he told Steggell, Sheridan and others.

Some Medicare beneficiaries said Friday that they’d seen and heard enough.

Gladys White, who has until May to enroll in a private plan under the Medicare program without incurring a penalty, said she wouldn’t bother.

She paid more than $200 on Friday for her prescriptions for high blood pressure, and derided the program.

“It’s just too complicated,” said White, 87. “I’m not going through any hassle.”

“I’ll just stick with what I have,” she said.