GOP New Medicare Program A Total Catastrophe

GOP Medicare Plan A Total Disaster
Millions At Risk Of Death & Serious Injury

The GOP revised Medicare plan that was pushed through the House and Senate has killed off traditional Medicare and Medi-Cal programs by enriching HMOs beyond their wildest dreams, while leaving the poor and middle class without healthcare or their medications.

Millions of seniors across the nation are at risk of death or serious injury as a result, and are screaming out, "Death to the GOP", while trying to get a pharmicist to serve their medical needs.

This attack on the sick and elderly is unprecedented.

See articles below...


States Intervene After Drug Plan Hits Snags

By ROBERT PEAR
January 8, 2006
New York Times

WASHINGTON, Jan. 7 - Low-income Medicare beneficiaries around the country were often overcharged, and some were turned away from pharmacies without getting their medications, in the first week of Medicare's new drug benefit. The problems have prompted emergency action by some states to protect their citizens.

Although there are no hard numbers, concerns expressed by state officials and complaints from pharmacists suggest a widespread pattern of problems.

At least four states - Maine, New Hampshire, North Dakota and Vermont - acted this week to make sure poor people received the drugs they were promised but could not obtain through the federal Medicare program.

Gov. Jim Douglas of Vermont, a Republican, said the state would pay drug claims for low-income people until the federal government fixed problems in the new program, known as Part D of Medicare. Michael K. Smith, the state's secretary of human services, said, "The federal system simply is not working."

On Thursday, the Vermont Legislature passed a bill declaring, "There is a public health emergency due to the federal implementation of Medicare Part D, which has resulted in serious operational problems, causing Vermonters to be turned away at the pharmacy without the drugs they need."
Many factors contributed to the initial chaos. Some people who enrolled in Medicare drug plans did not have any proof of coverage. Pharmacists could not get the information needed to verify eligibility for drug benefits and low-income subsidies. Insurance companies and their pharmacy benefit managers were swamped with calls, so pharmacists often had to wait an hour or more on telephone help lines.

Federal officials promised improvements, but state officials were growing impatient.
In Maine, Gov. John Baldacci, a Democrat, agreed to pay drug claims to provide medications for those in need. Since Tuesday, the state has incurred $2 million of expenses for Medicare beneficiaries.

On Friday, Gov. John Hoeven of North Dakota, a Republican, said he had to act because "some low-income elderly and disabled individuals can't get their prescriptions filled through their Medicare drug plans."

In New Hampshire, Gov. John Lynch, a Democrat, signed an executive order authorizing the state to pay drug claims that he said should have been covered by Medicare. Republican leaders of the state legislature called a special session to provide the money. The start of the Medicare drug program "has been a nightmare for many of our citizens," Governor Lynch said.

"Many are being charged unaffordable co-payments for prescription drugs - co-pays much higher than they are supposed to be. Too many of them are leaving pharmacies without their prescriptions."

Thomas T. Noland Jr., a spokesman for Humana Inc., a major national insurer, said that some problems were "to be expected in a new program with lots of new enrollment taking effect all at once."

Cynthia G. Tudor, a senior Medicare official, told insurers on Wednesday that they must "immediately make improvements" to "ensure that all beneficiaries get their prescriptions filled at the point of sale."

In a memorandum to insurers, Ms. Tudor said she had received "numerous reports" that they were "inappropriately denying some scripts," or claims. In many cases, she said, insurers are not providing the data that pharmacies need to file claims and get paid.

Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said on Saturday that he was working closely with states to address their concerns and to help individual patients. "We are filling close to a million prescriptions a day, including hundreds of thousands for low-income beneficiaries," Dr. McClellan said. "Many, many people are getting the prescriptions they need."

But in an interview on Friday, Stan Rosenstein, the Medicaid director in California, said: "We are hearing more and more complaints. A significant number of people are not getting their prescriptions. That has us very troubled."

Drug benefits are delivered by private insurers under contract to Medicare. The federal government is supposed to compute the subsidy available to each low-income beneficiary. But Michael Polzin, a spokesman for Walgreens drug stores, said that, in many cases, that information had not been shared with insurers or pharmacists.

Under Medicare rules, each drug plan is supposed to have a transition policy, providing a temporary supply - typically 30 days - of any prescription that a person was previously taking. But customer service representatives at Medicare's toll-free telephone number said they knew nothing of this requirement, and beneficiaries said it had been virtually impossible to take advantage of it.
Nationwide, 6.2 million low-income people receive both Medicare and Medicaid. About 1.1 million of them live in California. They tend to have many chronic illnesses and high drug costs. Cheryl Meronk, manager of the health insurance counseling program in Orange County, Calif., said she was referring people to hospital emergency rooms because they had been unable to get urgently needed medications through Medicare.

Under the standard Medicare drug benefit, which took effect on Jan. 1, the patient pays a $250 deductible and 25 percent of the next $2,000 in annual drug costs.

Over the last year, Medicare officials repeatedly assured poor people that they would receive extra help, so they would not have to pay any deductible and their co-payments would not exceed $5 a prescription.

But Carol A. Herrmann-Steckel, commissioner of the Alabama Medicaid Agency, said that Medicare beneficiaries with very low incomes had often been required to pay the full $250 deductible and co-payments far exceeding $5. "One beneficiary borrowed the money," she said. "Another charged the $250 on a credit card because she was in such dire need of the medicine."

Beverly R. Churchwell, an aide to the Alabama commissioner, said: "Some Medicare beneficiaries have not been able to get their medications. They are being turned away at the pharmacy."
John J. Morris, 42, of Ware, Mass., who has diabetes and multiple sclerosis, signed up for a Medicare drug plan on Nov. 16. The insurer told him his co-payments would not exceed $5, he said, but at the pharmacy this week, he was told he had to pay $23 for each of three drugs.

"I could not afford it," Mr. Morris said, "so I was not able to get my insulin or my M.S. drug."
In Oregon, Sandy K. Hata, a field manager for the State Department of Human Services, said: "We've had calls from people in tears who could not get their medications. These people were being asked to pay a $250 deductible and hundreds of dollars in co-payments."

Jane-ellen A. Weidanz, the Medicare project manager at the Oregon Department of Human Services, said, the $250 deductible "is hitting people very hard," adding: "People are very angry and very upset. They are yelling at us. They feel that we lied to them. They feel Medicare lied to them. They feel they cannot trust anything we say about this program."

Texas reported a similar problem. Low-income beneficiaries are "being charged incorrect (high) co-payments," the state's Health and Human Services Commission said in an e-mail message to the Dallas office of the federal Medicare agency.

In Oklahoma, low-income Medicare beneficiaries were often charged the $250 deductible. "They are being treated as if they were in a higher income bracket," said Mike Fogarty, chief executive of the Oklahoma Health Care Authority. "It's a common problem."

Steven E. Hahn, a spokesman for AARP, which offers a drug plan insured by UnitedHealth Group, said he knew that some low-income people had had difficulty getting medications. "We are taking this very seriously," he said. "This is a global problem, a systemwide problem, for all plan sponsors."

Elizabeth L. Stone, 86, who lives alone in an apartment in Manchester, N.H., is enrolled in both Medicare and Medicaid, has arthritis and a thyroid ailment and is in a wheelchair. She tried to use the new Medicare benefit to fill a prescription this week, but failed.

"I did not get any medication," Ms. Stone said. "People at the pharmacy would not give it to me because they do not know how they will be reimbursed."

Another low-income beneficiary, Terence J. Stevens, 65, of Lakeland, Fla., said he signed up for the drug plan on Nov. 15, the first day on which enrollment was allowed. His plan tried to charge him a $47 co-payment for a drug to treat irregular heartbeats and high blood pressure. Mr. Stevens said he was unable to pay and did not get the drug.

In Alabama, William M. Beasley, a pharmacist and a Democratic member of the State House of Representatives, said, "I have had more difficulty trying to process claims for Medicare recipients than I've had with any other insurer in 43 years as a pharmacist."

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Medicare Drug Plan Hits Snags in State
Beneficiaries trying to get prescriptions under the new program run into computer problems and long waits on hold; officials ask for patience.

By Ricardo Alonso-Zaldivar
LA Times Staff Writer
January 7, 2006

WASHINGTON — California health officials reported Friday that database errors and overloaded telephone help lines were spreading confusion and frustration among seniors seeking vital medicines under the new Medicare prescription program.

Though some warned of a looming crisis, Medicare officials and insurance companies called for patience and promised swift relief.

California pharmacists, on the frontline of the new program, complained that improvements were coming too slowly.

"There's a large amount of problems out there," Stan Rosenstein, the state's deputy director of medical services, said in an interview. "We are significantly worried. When it gets to a situation where people aren't getting their medications, that is very concerning to the state."

Most of those affected are low-income seniors and disabled people.

Lakewood resident Andrew Gnagy said it took him about 15 hours on hold on the telephone over three days to get prescription refills arranged for his 84-year-old mother. Sue Gnagy has heart problems, diabetes and a thyroid condition. The pharmacy said it would cost $974.26 to buy the drugs directly — about $40 more than his mother's monthly Social Security check.

Until Jan. 1, she had been getting her prescriptions at very little cost through Medi-Cal, California's version of the federal-state Medicaid health program.

Under the system that took effect Sunday, about 1 million Medi-Cal beneficiaries had their drug coverage switched automatically to a private insurance plan subsidized by Medicare.

"Many people in my mom's situation, without their medicines, would die," Gnagy said. "People who have no one to advocate for them and don't have the stamina to stay on the phone 12 or 15 hours will just go without their medicines."

Though acknowledging problems, federal officials defended the new program and said hundreds of thousands of seniors had been getting their prescriptions without incident, many at lower cost.

The drug benefit is considered one of the Bush administration's main domestic policy achievements. It offers outpatient prescription coverage to 43 million elderly and disabled beneficiaries through government-subsidized private plans, at an estimated cost of $700 billion over 10 years.

California is critical to the program's success, because the state has a nation-leading 4 million people on Medicare, including the 1 million previously served by Medi-Cal.

"All we are asking for is a little patience — hours, not weeks — until we can get a handle on individual cases," Medicare senior policy advisor Larry Kocot told reporters on Thursday. "We are chasing down everything that we hear. We are addressing [problems] and addressing them to our satisfaction."

Kocot said Medicare had fixed technical problems that had initially hobbled a database for pharmacists. The agency also urged companies offering drug plans to beef up staffing at swamped telephone call centers.

Advocates for the poor have reacted with dismay to the problems, saying their warnings that a sudden transition would cause such problems went unheeded.

"This is a public health disaster," said Jeanne Finberg, a lawyer in the Oakland office of the National Senior Citizens Law Center. "There are people going to pharmacies and being told they can't get medications that are supposed to be covered. There are people who can't get confirmation that they are in a plan."

Across the country, about 6 million low-income elderly and disabled people were automatically switched into Medicare drug plans on Jan. 1.

At least one state, Vermont, found the problems for low-income beneficiaries so overwhelming that it decided to use state funds to pay their prescription bills until Feb. 10.

"It just wasn't working," Joshua Slen, Vermont's Medicaid director, said Friday.

Vermont estimates it will cost $7 million to provide the transitional coverage for its 30,000 Medicaid beneficiaries, and Republican Gov. Jim Douglas is demanding that Washington "fully reimburse" the state.

For California, with more than 30 times as many Medi-Cal beneficiaries being transferred, the cost to duplicate Vermont's approach would be prohibitive.

However, other New England states are considering similar emergency relief, Slen said.
Echoing Medicare officials, the health insurance industry also is urging patience.

"Challenges are being faced where they arise," said Mohit M. Ghose, a spokesman for America's Health Insurance Plans, the main industry trade group. "Given the amount of resources that are now being dedicated to improving systems, including call-center capability for pharmacies, any snapshot you take today could change."

In California, pharmacists say they are not seeing the improvements fast enough.

"It's incredibly frustrating, because it appears that [Medicare] and the [drug] plans are expecting us to be the point people for all of the problems," said John Cronin, senior vice president of the California Pharmacists Assn. "If the patients can't get their medicines, they are going to have to come in again and again until this is resolved."

Cronin, who owns Community Pharmacy of Escondido, said he dreaded to think what would happen when pharmacies started to deal with problems considered more difficult to resolve, such as when a plan denies coverage for a particular drug.

"The problems that we are having now concern eligibility and billing," he said. "This is very basic stuff, the kind of thing that should have been taken care of long before this plan rolled out."
The issues are technical, but according to pharmacists and state officials, the problems revolve around accuracy and access.

Many beneficiaries still do not have membership cards from their drug plans, and a Medicare database where pharmacists can verify enrollment is riddled with errors concerning eligibility and co-payments. California's Rosenstein said one of the state's large pharmacies reported an error rate of about 40%.

Such errors mean that computerized billing requests from pharmacies to the plans are automatically rejected. But when a pharmacist calls to try to resolve the problem, help is frequently unavailable because phone lines are tied up with other callers.

"Unfortunately, those lines are the only lines that can give the provider the information they need," said Rosenstein.

Gnagy, the Lakewood resident who cares for his elderly mother, said his mother did have her membership card for her new insurer, called the Blue Cross Medicare Rx Value Plan. But when Gnagy went to Sam's Club pharmacy in Long Beach on Monday, the pharmacist was unable to get the computerized bill through to the insurer.

Pharmacy staffers called the insurer to no avail.

"They called me Tuesday and said, 'We can't get these people to answer the phone — you might have better luck,' " Gnagy said.

"I put in a total of 15 1/2 hours of dialing and being put on hold," he added. "My longest session was 6 1/2 hours — I have a hands-free phone."

By Wednesday, Gnagy said, he started to panic, because some of his mother's 12 medications were running out. Her social worker gave him some numbers to call. One of them turned out to be a local agency that protects the elderly from abuse. He said agency officials misinterpreted his frustration as an indication that his mother was in danger, and soon an enforcement officer was at the door.

"I felt extremely violated," he said. "They came in and physically checked my mom for bruises."
On Thursday morning, said Gnagy, he was finally able to reach the drug plan and obtain a telephone number the pharmacy could call. On Friday, the pharmacy called to say his mother's prescriptions were ready.

Things will get better, said a spokeswoman for the parent company of the Blue Cross plan, WellPoint. "We apologize for any delays," said Kellie Bernell. "We are doing everything to open lines and increase service to our beneficiaries."

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Click below for links to Medicare Disaster articles below...

http://news.search.yahoo.com/search/news?fr=FP-pull-news-t&ei=UTF-8&p=medicare+problems

1. Widespread Problems With New Medicare Plan 
Free Internet Press - Jan 07 1:12 PM
Low-income Medicare beneficiaries around the country were often overcharged, and some were turned away from pharmacies without getting their medications, in the first week of Medicare's new drug benefit. The problems have prompted emergency action by some states to protect their citizens. Although there are no hard numbers, concerns expressed by state officials and complaints from pharmacists
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2. Pharmacists struggling with Medicare drug plan problems 
The Parsons Sun - Jan 07 6:30 AM
Pharmacists in Parsons are struggling with the new Medicare drug plan that started this week. Medicare Plan-D has also caused problems for those who are supposed to receive benefits from the plan.
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3. Pharmacists overwhelmed at new Medicare drug program 
Stamford Advocate - Jan 08 9:32 AM
NEW HAVEN, Conn. -- The start of the Medicare prescription drug plan for seniors has been difficult for pharmacists in Connecticut. Pharmacists are helping bewildered beneficiaries, dispensing medications at their own expense and are working out problems with overwhelmed insurance plans.
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4. Governor authorizes state to help with Medicare problems 
WTNH-TV New Haven - Jan 07 7:15 PM
(Hartford-AP, Jan. 7, 2005 10:10 PM) _ Governor Rell has approved special payments to help low-income elderly people affected by the start of the national Medicare prescription drug program.
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5. Rell Authorizes Medicare Prescription Payments 
Hartford Courant - Jan 08 4:41 AM
HARTFORD, Conn. -- Gov. M. Jodi Rell has authorized the state to pay pharmacies directly when low-income elderly and disabled people have problems with eligibility for the new national Medicare prescription drug program.
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6. One week into it, seniors mired in Medicare D mess 
Portsmouth Herald - Jan 08 6:22 AM
Kathleen Garror was denied her prescription when she went to her pharmacist on Friday. The Portsmouth resident is on both Medicare and Medicaid - among the so-called "dual eligibles" who are encountering so many problems throughout New England - and takes upward of 15 medications each month.
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7. Officials say they're trying to fix Medicare problems 
Grand Forks Herald - Jan 07 11:00 AM
ST. PAUL - A Medicare official says the problem that has left hundreds of poor Minnesotans unable to get their prescription drugs may be a systems issue that can be identified and quickly fixed.
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8. Green: Medicare plan has a ‘hole’ in it 
Baytown Sun - Jan 07 6:58 PM
BAYTOWN — Congressman Gene Green, D-Houston, said Saturday a benefit hole in the middle of the Medicare prescription drug plan, among other problems with the system, is going to impair American healthcare instead of help it.
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9. Governor Rell authorizes payments during Medicare prescription transition 
WFSB 3 - Jan 07 4:26 PM
HARTFORD (AP) - Governor M. Jodi Rell has authorized the state to pay pharmacies directly when low-income elderly and disabled people have problems with eligibility for the new national Medicare prescription drug program.
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10. Seniors encounter problems with Medicare drug benefit 
Knight-Ridder Washington Bureau - Jan 06 3:44 PM
WASHINGTON - Many of Medicare's poorest and most sickly patients are going without their medications because of administrative glitches, misinformation and confusion surrounding the new Medicare prescription drug benefit.
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11. Eligibility Verification Problems Affect Launch Of New Medicare Prescription Drug Benefit, USA 
Medical News Today - Jan 05 4:10 PM
Some Medicare beneficiaries who enrolled in the new drug benefit were unable to fill their prescriptions this week because of problems verifying their eligibility, pharmacists and advocates for seniors said, the Chicago Tribune reports.
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12. Medicare drug plan hits some glitches 
Tacoma News Tribune - Jan 07 3:01 AM
The new Medicare drug benefit program, which started Sunday, is causing headaches for local pharmacists and seniors as they struggle with computer glitches and other problems.
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13. Pharmacists overwhelmed at new Medicare drug program 
WTNH-TV New Haven - 12 minutes ago
(New Haven-AP, Jan. 8, 2006 6:20 PM) _ The start of the Medicare prescription drug plan for seniors has been difficult for pharmacists in Connecticut.
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14. States Wading in to Fix Medicare Mess 
RedNova - Jan 08 11:17 AM
By Robert Pear New York Times News Service WASHINGTON -- Low-income Medicare beneficiaries around the country were often overcharged, and some were turned away from pharmacies without getting their medications in the first week of Medicare's new drug benefit.
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15. New Medicare Program Creating Problems 
WTOV 9 Steubenville - Jan 06 3:27 PM
The new Medicare plan kicked in on the first of the year and some people are saving some big money, but others are left frustrated and unable to get discounted drugs.
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16. Medicare benefit has bitter aftertaste 
Salt Lake Tribune - Jan 06 11:49 PM
As feared, some of Utah's most vulnerable residents - the old, ill and poor - are having problems or are not getting their prescriptions filled under Medicare's new drug benefit. They're called dual eligibles: 21,000 Utahns on Medicare whose drugs had been covered by Medicaid. If they didn't choose a new plan themselves, they were supposed to be automatically transferred to a randomly
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17. Missing Out on Medicare Drug Benefits; Glitches, Confusion Hurt Many in New Program 
RedNova - Jan 08 9:17 AM
By Tony Pugh Many of Medicare's poorest and most sickly patients are going without their medications because of administrative glitches, misinformation and confusion surrounding the new Medicare prescription drug benefit.
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18. A Map for the Medicare Maze 
Newsweek - Jan 07 11:11 PM
Jan. 16, 2006 issue - Computer crashes, jammed phone lines, longtime prescriptions no longer covered-but also a lot of prescriptions smoothly and rapidly filled. That was the look of the new drug benefit known as Medicare Part D, which was launched last week. Glitches are frustrating, of course.
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19. Nightmare first week for new Medicare plan 
WBBH - Jan 08 2:31 PM
FORT MYERS — Medicare’s purpose is to protect you from those unexpected drug expenses.
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20. South Dakota Offers Help To Medicare Part D Participants 
KELOLAND - Jan 07 6:38 AM
The state of South Dakota is offering help for some seniors who've run into problems with Medicare Part D. The department of social services will pay for emergency 30 day supplies of medications until January 27th for dual eligible Medicare-Medicaid recipients.
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