Mental Health Part D

Mental Health Part D News Alert

January 12, 2006

7 States -- California, Massachusetts, New Hampshire, New Jersey, Pennsylvania, South Dakota, and Vermont -- have already acted to ensure that their Medicare beneficiaries, including dual eligibles, will receive their necessary medications despite problems with the implementation of the new Medicare prescription drug benefit, Medicare Part D. What follows below is specific information about what's happening in MA, VT, CA, and PA.

Massachusetts
Summary: Gov. Mitt Romney had state health officials order pharmacists to fill prescriptions under the new Medicare drug plan. The action was taken after a federal Medicare officials spoke with state officials about similar measures taken by other states such as VT, CT, NH and ME. The move costs MA between $1.5 and $2 million per day and ensure three groups will receive prescriptions immediately: low-income seniors, disabled people on Medicaid, and those receiving benefits under state’s Prescription Advantage program. Approximately 262,000 MA residents are affected.

Low-income seniors and disabled people already enrolled in the federal government's new drug plan are being turned away by Bay State pharmacists - forcing state officials to step in and foot the bill.
But some seniors aren't getting their medications because Massachusetts pharmacists can't verify that they've enrolled in the new plan.
Pharmacists are also spending up to an hour on the phone trying to confirm whether customers are eligible.
MassHealth plans to front the prescription costs indefinitely and will seek reimbursement from private insurers or the federal government, officials said.
``The goal is for it to not cost the state extra money,'' said Timothy Murphy, Massachusetts' secretary of Health and Human Services.
``We felt this was an appropriate short-term step to address transitional issues regarding Medicare part D.''
In Massachusetts, there are about 190,000 dual-eligible seniors and disabled people.
Source: The Boston Herald, January 10, 2006
The Romney administration said Monday the state will temporarily pick up the cost of prescription drugs for low income seniors and the disabled who have been turned away at pharmacies because of confusion under the new federal Medicare prescription drug benefit.
"Given reports about what is happening in pharmacies, Gov. Romney has made it clear that we have an obligation to make certain that MassHealth members receive their medication when they need it," state Medicaid Director Beth Waldman said in a statement. "The complexities of Part D make it a difficult program to implement perfectly."
MassHealth, the state's Medicaid program, began notifying all the state's pharmacies on Monday of its decision. Pharmacies will continue attempting to bill the federal government as the primary payer, but as a fallback can also bill the state's MassHealth directly.
Sen. Edward Kennedy, D-Mass., praised Romney, but said the state's effort shows the flaws in the new federal prescription drug benefit.
"The system wide failure of the new Medicare Drug program is unacceptable and puts the health of our frailest citizens at great risk," Kennedy said a statement.
State lawmakers last month approved, and Lt. Gov. Kerry Healey signed into law, another policy guaranteeing an emergency 30-day supply of prescription drugs to seniors. That program was intended to help seniors if their medication is not covered under their new Medicare policy.
Source: The Boston Globe, January 9, 2006

Vermont
Summary: VT lawmakers took emergency action Thursday, January 5, in order to allow recipients of Part D to temporarily revert back to the way they previously purchased drugs by providing $7 million dollars in funding. The emergency legislation affects some 30,000 poor and disabled Vermonters.

The federal program is designed to replace a series of local Medicaid programs that provided about $7 million in drug subsidies each month.
"I had one case that was life-threatening," said Kim Maynard, central Vermont coordinator for the State Health Insurance Assistance Program. "I have a lot of real emotionally charged clients because people are not getting their medication."
Vermont lawmakers and the governor's office on Wednesday were horrified to learn how poorly the new federal system was treating their "most vulnerable" constituents, and took emergency action to immediately revive the old state payment system.
The old system will go back into service today.
"We have Vermonters out there who are confused, and we need to assist them," said Michael Smith, secretary of the Agency of Human Services.
"We promised last year that people would be held harmless during the transition," said Sen. Susan Bartlett, D-Lamoille, chairwoman of the Senate Appropriations Committee. "And that is what we are doing."
Bartlett said no one thinks that all $7 million will be needed, and everyone expects the federal government to repay the state.
"We expect to be reimbursed," Bartlett said. "But that is a fight we will have another day."
Source: The Rutland Herald, January 6, 2006
We also need to work together to address the federal Medicare implementation challenges that are currently afflicting the entire nation. We must ensure that Vermont seniors have access to the prescription drugs they need at the price they were promised.
Earlier today, I directed the Agency of Human Services to immediately reinstate benefits to seniors who were previously enrolled in one of Vermont’s prescription drug programs. This means that no senior who relied on state government for medicine will be turned away from a pharmacy. They will get the drugs they need and Vermont will continue to guarantee their affordability.
In addition, we will continue to press the federal government to quickly address these implementation challenges so seniors can take advantage of the federal prescription drug benefit program they were promised.
Source: “State of the State Address.” Governor Jim Douglas. January 5, 2006

California
Summary: Database errors and congested phone lines spread confusion and frustration across CA. Pharmacists say they have been unable to fill prescriptions or have given out drugs without knowing if they will be paid since Part D began on 1/1. Computer problems verifying a patient's eligibility, busy help lines and mismatched identification numbers also have hampered the ability of pharmacists to fill orders.

Mark McClellan, head of the agency that oversees the program, points out that it is filling as many as a million prescriptions a day. But it appears low-income seniors and disabled people known as "dual eligibles" -- the 6 million Americans covered under both Medicare and Medicaid, the federal program for the poor -- are disproportionately having problems. Unlike everyone else -- who have until spring to sign up before getting penalized -- those on Medicaid had to switch to the new drug plan on the first day.
The problem: Federal officials didn't process all of their applications on time, so when an untold number of the poorest and often sickest seniors went to fill their medications in recent days, they weren't in the computer. At least four states -- Maine, New Hampshire, North Dakota and Vermont -- have already decided to spend millions to care for those who are slipping through the cracks, even though it is unclear whether the federal government will pay them back. As of Tuesday, California officials said they were considering doing the same. The tab could exceed hundreds of millions of dollars.
Source: Los Angeles Times, January 11, 2006
Under the new plan that took effect Jan. 1, the government will pay about half of the drug costs of the typical person with Medicare. But participants must select their own private insurance plan and benefits vary widely by individual. In California, 18 companies are offering 40 different plans, which charge different premiums, require different co-payments and cover different types of drugs.
A regional administrator with the Center for Medicare and Medicaid Services, Steve Deering, told the more than 300 people who gathered at College of Marin's Olney Hall that he was aware of many problems.
Deering said Medicare has intervened to help several hundred people in California who faced medical emergencies get prescription refills.
"What we are dealing with is a situation that is serious," Deering said.
Many of Marin's independent pharmacies couldn't prescribe medications to these "dual eligibles" last week because five of the 10 health plans designated to serve this population had made no effort to register the pharmacies.
"These are people with disabilities and mental problems - the sickest of the sick," Fred Mayer, retired Sausalito pharmacist and vice president of the Marin County Pharmacy Association said.
Benson Toy, the owner of the Marin Medical Pharmacy in San Rafael, said he couldn't fill a prescription for an antibiotic brought in by a dual-eligible woman last Tuesday because his pharmacy wasn't registered with her insurer, Sierra Rx Sense.
Source: Marin Independent Journal, January 10, 2006
Larry Kocot, senior policy adviser for the Centers for Medicare and Medicaid Services in Washington, D.C., said millions of prescription were filled under the Medicare program last week, and many beneficiaries saw savings they had never seen before.
Although he acknowledged problems, he said that early January is typically a transitional time for people who have switched insurance plans or signed up for new ones. With the addition of millions of new Medicare beneficiaries, processing delays had to be expected, he said.
As of Dec. 15, 1 million elderly and disabled people had voluntarily signed up for a government-subsidized insurance plan while 20 million more were automatically enrolled or already had retirement plans that included drug coverage. Tens of thousands more a day signed up in late December.
"It's not the fault of the pharmacists, it's not the fault of the CMS, it's not the fault of the patients," said Kocot. "It's just that this is going to take some time. And all we are asking is that people give us just a few days to get things up and running in the way we want to see it run."
Source: Daily News (LA), January 9, 2006
"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.
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."
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."
Source: Los Angeles Times, January 7, 2006
At Galloway's Pharmacy in San Diego, the state's largest independent retail pharmacy, pharmacist Fadi Atiya said he has handed out about $30,000 worth of medication this week without knowing whether he will be reimbursed.
"You can't access the patient's ID. When you call (the insurer), the wait time is 45 minutes to an hour and 15 minutes," Atiya said, describing just a few of the problems. "It's a comedy of errors, but it's not funny, because there are people's lives at stake."
Atiya said he thought the government made a mistake by switching over dual eligibles into the new program on Jan. 1. He said the program should have been phased in more slowly. Options would have been to start with a smaller geographical region or a less vulnerable group.
"They took the people who really can't fend for themselves -- the mentally disabled, HIV-positive, people with seizure disorders, the sickest of the sick -- and they threw these people to the lions," he said.
Source: The San Francisco Chronicle, January 6, 2006

Pennsylvania

“Ms. Vilaret, the Eckerd official, said initial problems with a computer system to check the coverage status of people enrolled in both Medicare and Medicaid largely were resolved by yesterday. But consumer advocates said many of these patients, known as "dual-eligibles," still were having troubles.
Dual eligibles had the option of choosing a plan providing Part D coverage or being automatically assigned to one. As part of the transition to the new Medicare program, some dual-eligible patients in the urban areas of the state have been switched into health plans with limited networks of doctors and hospitals.
While federal officials have taken a variety of steps to ensure that dual eligibles will continue to get the drugs they need -- including allowing them to change Part D plans at any time, Alissa Halperin, managing attorney with the Pennsylvania Health Law Project, said, "We have people who are due to start chemotherapy tomorrow and the hospital suddenly isn't in their network."
Source: Pittsburgh Post-Gazette, January 4, 2006
Health plan officials said they were working to resolve consumer problems as they learned of them, adding that thousands of people were receiving medications without incident.
It seems like it's working for some people, and for those people it's been fantastic -- they're getting their medicines and saving money," said Jessica Lippert with the Apprise counseling service in Altoona. "In some other cases, it seems like there are data transmission issues that have caused problems with people getting their drugs."
Many of the patients in the latter category are the so-called dual-eligibles -- people who qualify for both Medicare and Medicaid.
Some dual-eligible patients were automatically enrolled in new Medicare drug plans as of Jan. 1, but showed up at the pharmacy not knowing which company was providing their benefits, said Fran Chervenak, an attorney with the Pennsylvania Health Law Project in Pittsburgh. Other dual-eligible patients simply were overlooked and never assigned to a plan.
In both instances, patients haven't been able to obtain drugs because their coverage status couldn't be determined at the pharmacy, Ms. Chervenak said. Although the government has talked about having safeguards so patients lacking documentation can get medicine, the back-up systems don't seem to be working in all cases.
"We've talked with hundreds of consumers in the past four days who are dual-eligible and either have no idea what plan they're in, or they don't have any verification that will allow them to get their medications at the pharmacy," she said. "It's been a mess."
Source: Pittsburgh Post-Gazette, January 7, 2006
Nationally, a federal health official acknowledged delays and snags prompted Medicare to employ extra phone operators, encourage insurers to add staff and fix computer software glitches.
"We have heard there have been some bumps in the road," Larry Kocot, a senior policy adviser with the Centers for Medicare and Medicaid Services said Thursday. "But as they come up, we address them. Every day we are making progress."
Kocot said many of the problems pharmacists have encountered are typical for January, when many Americans switch health plans.
But this year's transition has been aggravated, he said, by the sudden surge in Medicare Part D enrollees who wanted the drug benefit to start Jan. 1. About 21 million senior citizens and people with disabilities either signed up or were automatically enrolled into one of dozens of drug plans managed by private insurers.
Source: Morning Call (Allentown), January 6, 2006
Seniors across Lancaster County and the country enrolled in the federal government's new drug program, called Medicare Part D, have encountered numerous glitches. Some enrolled in a plan, but never received a card.
Some had documentation for their enrollment but found it was worthless. Some were automatically enrolled in a plan but were not notified which one. "It's a confusing nightmare for now," said Jacqueline Burch, director of the Lancaster County Office of Aging.
The Office of Aging has been inundated with calls from people having problems with the program. "Yesterday was particularly crazy," Burch said. Some of the folks calling for help were those eligible for both the Medicare program for seniors and the Medicaid program for low-income people. Those "dual-eligible" patients were automatically enrolled in a program by the government. But when they got to the pharmacy, the druggist often could not ascertain which program it was.
Source: Lancaster New Era, January 4, 2006

Posted 1-19-2006