Changes to Medicare's prescription drug program have been troublesome for many, who are eligible for Medicare and Medi-Cal, because of problems with automatic enrollment. Medicare's prescription drug program went into effect Jan. 1 and, as many expected, thousands of beneficiaries are running into difficulties trying to get their prescriptions filled at the pharmacy.
The majority of people who are having problems are those who are eligible for both Medicare and Medi-Cal, California's version of Medicaid. Their Medi-Cal prescription benefits expired Dec. 31, and they should have been automatically enrolled in one of the Medicare-approved drug plans if they did not select one on their own.
Cheryl Meronk, Health Insurance Counseling and Advocacy program manager, said the Council on Aging of Orange County continues to get a huge volume of calls -- the majority from the dually eligible beneficiaries who have not been able to get their drugs.
She said many of those people either don't show up in the computer or they are in a plan but are not being recognized as a Medi-Cal beneficiary. To receive their medications, they are then being asked to pay a large sum of money toward the standard $250 deductible.
Jack Cheevers, director of communications for the Centers for Medicare and Medicaid Services, said the problems are with those who are dually eligible who were auto-enrolled into one program and decided to switch plans. He said a lot of them have not been properly entered into the computer system.
Cheevers said they are working hard to straighten out these problems. The Centers for Medicare and Medicaid Services is doing additional training with pharmacists to be sure that these drugs are billed correctly, and have added 4,500 phone operators to the pharmacists hotline. For people who are in an emergency situation and could face serious health problems without their medication, he said, they are being referred to case workers who handle them on an individual basis.
"We've definitely hit some snags," Cheevers said, "but we're working very hard to iron them out quickly, and we think we're making progress."
Meronk said they are receiving an extremely high number of calls from people who are saying they have not been able to get their medication and could become ill without it.
"We're probably getting more than 100 calls a day from people who can't get their medications," she said.
Unfortunately, Meronk said, all they can really do is refer them to 1-800-MEDICARE and tell the operator that theirs is an emergency case.
"1-800-MEDICARE is not being as responsive as we would like them to be," she said, adding that many people have called back after talking to Medicare representatives and said they were told that operators were too busy to help them.
Meronk noted that the entire staff and many volunteers at the Council on Aging have been working overtime, trying to help everyone as best they can. All of the volunteer counselors are completely booked up, and their phone lines are tied up most of the day.
"I'm looking at this telephone right now, and every single one of our lines is lit up," she said. "Its like that almost every minute of the day."
Cheevers said the drug prescription program is the biggest change to Medicare in 40 years.
"I think the big picture is that we're filling 40,000 prescriptions an hour," he said, adding that millions have been filled since Jan. 1. "It's generally running fairly well. We're working really hard to zero in on the problems with the [beneficiaries who are dually eligible] and get those cleaned up."
As a result of all the issues with the new drug program, pharmacies have been swamped since Jan. 1.
Akram Nesheiwat of Huntington Beach went in to Steven's Pharmacy in Costa Mesa on Thursday to fill his prescriptions for the first time this year. When he got there, he was informed that he is not in the system and has not been assigned a plan.
"They gave me temporary medicine for two weeks," he said. "Now I have to call Medicare and see which plan they will put me in.... Hopefully everything will get straightened out."
Meronk said she has heard that officials at Medicare have said they expect to have the problems fixed by the end of the month, but she remains skeptical.
"The system is not working, and it needs to be fixed," Meronk said.
* LINDSAY SANDHAM is the news assistant. She can be reached at (714) 966-4625 or firstname.lastname@example.org.
20060114it1tw1ncMARK DUSTIN / DAILY PILOT(LA)Lennie Pham, left, a clerk at Steven's Pharmacy in Costa Mesa, hands Akram Nesheiwat, right, of Huntington Beach, his prescriptions Thursday afternoon. Nesheiwat wasn't in the changed Medicare program, but he was able to get a two-week supply of his medication to get him through until he is enrolled.