Mixed Reactions Continue As Drug Plan

Enrollment Deadline Approaches

By Nancy K. Crevier

With the May 15 deadline looming, state agencies are seeing a final flurry of activity as seniors across Connecticut select and sign up for the Medicare Part D Prescription Drug Plan.

Medicare Part D has been designed to provide prescription drug insurance to senior citizens who previously have not had prescription drug coverage.

When sign-ups began in November of 2005, flaws in the system initially created chaos for seniors and the agencies that help them, as the glut of potential customers and confusion about the process clogged the procedure. The snags have since been remedied, for the most part, said Dawn Macary of the Connecticut Agency on Aging, and eligible citizens have been steadily signing up throughout the winter months.

“The only people who are really having any problems are ConnPACE customers,” she said. ConnPACE is a prescription drug program for low-income residents of Connecticut. The Medicare Part D program was designed to wrap around ConnPACE, allowing its customers to continue to pay one low price for prescription. Because the Center for Medicare and Medicaid Services (CMS) did not send data to ConnPACE in a timely fashion, a number of the 49,000 ConnPACE clientele did not receive the ConnPACE card needed to receive their prescriptions, said Ms Macary. However, even this problem is coming under control now, she added.

“There has been a big influx of people signing up in the last couple of weeks,” she said, and additional volunteers have been staffing the seven area Agency on Aging counseling sites across the state. “There have been days when every telephone line has been lit up,” said Ms Macary, a positive sign that more of those eligible for the plan are taking advantage of it.

According to a press release issued in mid-April, Congresswoman Nancy Johnson said that sign-up projections of 28–30 million eligible citizens nationwide for this year have been surpassed. In Connecticut, 102,000 seniors who previously had no drug coverage have registered with Medicare Part D.

“The average senior is saving $1,100 a year, and I’ve met seniors in Connecticut who are saving even more,” said Ms Johnson. “Medicare’s momentum is undeniable.”

Not all of the state representatives are as happy with the Medicare Part D program, however. While seniors are able to sign up more efficiently as time goes by, the detritus of earlier problems with the program rankle Senators Chris Dodd and Joe Lieberman. The senators sent a letter to Secretary of Health and Human Service Michael O. Leavitt on April 10, expressing their displeasure with the manner in which CMS has handled reimbursements to states that picked up the slack in the early months of the program.

“…During the first three months of the new Medicare drug benefit many beneficiaries were unable to get their prescription drugs due to errors made by the Center of Medicare and Medicaid Services [CMS],” they wrote. “As a result of CMS’s failure, 46 states were forced to step in and pay for prescriptions on an emergency basis.” The senators maintain that CMS has not taken action to reimburse any of the states, including Connecticut, as of April.

CMS assistant regional administrator for Medicaid Richard McGreal said that the process for returning those funds to the states is now underway. “States have been requested to submit an eligibility file to CMS,” he said. The eligibility file is a list of the people for whom states have paid. CMS will then verify that the people listed are duel-eligible, an adjusted eligibility file will be returned to the state and the state will then submit to CMS the amount of the claim paid per person.

“The quicker states get eligibility files in to the CMS, the quicker the turnaround will be,” said Mr McGreal.

Pharmacists Still See

Problems

Pharmacists across the nation also remain largely dissatisfied with the Medicare Part D Prescription Drug Plan. A press release put out by the Connecticut Pharmacists Association on April 10 notes that a survey of nearly 6,000 pharmacists from every state finds 88 percent of the pharmacists polled looking for improvements in the program.

Day-to-day and financial problems have resulted for pharmacies since the inception of the program. For 45 percent of the pharmacists who responded to the survey, more than ten hours every week are spent resolving problems directly related to the Part D Prescription Drug Plan. Because pharmacists are finding that the plan providers will not negotiate terms, the reimbursement they receive is below average in the market. According to the press release, Congress expected Medicare Part D plans to negotiate for reasonable terms with the pharmacies. The “take it or leave it” attitude of the plan providers has left many pharmacies in the nation in financial distress.

Not only the pharmacies are taking a hit; survey findings reported that less than half of the pharmacists felt that the seniors are enrolled in plans best suited to the patients’ needs.

Contrary to the surveys reports, however, Don Bates, owner of the Drug Center on Church Hill Road said that Medicare Part D is actually working well for many of his senior customers. “This is a good thing for seniors. We see that they are taking their medicines properly now. Instead of medicines lasting 50 days, they are coming in to refill them in 30 days. That’s the important thing to us,” he said.

There is a cash flow concern so far as payments to the pharmacy goes, said Mr Bates, but added, “We have to try to live with this.” The Drug Center has seen a new rush of enrollees in the prescription plan the past two weeks and continues to help seniors select the plan that best suits each person.

The pace of enrollment continues to pick up locally at social agencies, as well. “We have been very busy the last two weeks [signing up seniors for Medicare Part D],” said Ann Piccini, director of Newtown Social Services. “There have been a few glitches when people are changing over plans, but it is going smoothly,” she said.

Like Ms Macary, the problems encountered at Social Services tend to involve ConnPACE customers, who must understand, she emphasized, that they are required to pick a prescription drug plan from one of the more than 40 options offered by Medicare Part D. “ConnPACE will automatically enroll members in a plan who have not picked their own,” she warned. The disadvantage to that, she said, is that members may not end up enrolled in a plan that is ideal for their situation. Newtown Social Services will help any eligible senior who needs aid in selecting a program and, said Ms Piccini, “The druggists are working with people, too, to help them select the right plan.”

Marilyn Place, director of the Newtown Senior Center, said the center has seen an increase recently in the number of eligible seniors seeking aid who have waited until this month to decide on a plan. “We were very quiet for awhile, but we are absolutely busier now with May 15 coming up.”

She finds that the seniors seeking assistance this spring are more comfortable than those who came in during the first few months of registration. “A lot of things have fallen into place. By having the seminars here and having a lot of information on hand, it has helped. [The senior citizens] feel more informed now.”

After May 15, the next enrollment opportunity will not be until November 15 through December 31. A person who joins during that enrollment period will pay a premium penalty of at least one percent for every month they were eligible but did not join. That penalty applies for as long as the client is part of Medicare Part D Prescription Drug Plan. Coverage for those who sign up at that time will not begin until January 1, 2007.

There is still time to squeak in under the wire and social service agencies urge anyone eligible to sign up by the end of Monday, May 15, if they have not already done so.

“What we don’t know yet,” said Ms Macary, “is if that penalty will be one percent of the national average for 2006 or one percent of the national average for 2007.”

Newtown Social Services can be contacted at 270-4330. To contact the Area Agency on Aging, call 800-994-9422.