November 24, 2024
Editorial

PART D, PART CHAOS

Gov. John Baldacci took a political risk last week when warning that Medicare’s new drug benefit, called Part D, would not be ready for seniors and was not nearly helpful enough to overworked pharmacists trying to fill prescriptions. The governor, however, is to be commended because he didn’t just warn of danger but had Maine take steps to anticipate the trouble and help Medicare recipients get the prescription drugs they needed.

State government estimates it has received more than 20,000 calls of complaint since Sunday, when the new drug plan became available to Medi-care recipients and mandatory for seniors who also receive Medicaid and for those who use the Low Cost Drugs for the Elderly and Disabled program, approximately 80,000 residents. The federal government had assigned these recipients randomly to private plans, whether their drugs were covered or not, but with the promise that for the next 30 days all their prescription drugs would be covered and they could switch to a more appropriate plan. Maine used a federal provision to try to match seniors to plans that better reflected their need for coverage.

Last Friday afternoon, Gov. Baldacci made public a letter he had sent to the federal Center for Medicare and Medi-caid Services (CMS) warning that gaps in coverage were apparent in Maine and would have dangerous consequences for seniors. CMS said forcefully that the governor was overreacting.

On Sunday, while some seniors were able to get their medications, many others found their prescription drugs weren’t covered and pharmacists couldn’t get answers from the federal government. Co-payments that were supposed to cost $1 or $3 for Medicaid recipients cost as much as $100 or $150, beyond the ability of many to pay. Others found that though they had a letter confirming they had been assigned to a plan, pharmacists could find no record of them; many others didn’t even get that far.

Jude Walsh of the Governor’s Office of Health Policy and Finance says the office received calls from someone denied coverage for dialysis medication, another who could not get heart medication, a third who said he was denied three drugs for a mental health condition and couldn’t be responsible for his actions. The Baldacci administration has since provided pharmacies with a means of billing the state to cover the drug costs of anyone who qualified under the previous programs until the new system can be worked out.

But it is important to note that this is not merely a problem in Maine. As a news story in The New York Times reports, Medicare recipients and pharmacists in New York, North Dakota, Florida and Texas – and no doubt many other states – report trouble trying to have Medicare claims processed, get through on help lines and persuade insurers to recognize coverage. If Maine is unusual, it is that its government anticipated the problems and acted swiftly once they arose.

Any system will have glitches, especially during startup. (That’s one reason not to pick the first week of a month, the busiest week for services, to start one.) What seems to have faltered with Medicare is the registering of so many recipients and the backup – once something went wrong at the pharmacy level, there appears to have been inadequate resources for pharmacists.

These problems can be fixed; good for Maine for not waiting for the federal government to make repairs.


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