JANUARY 20, 2005 -- Congress hasn't scheduled any hearings on the issue and isn't around anyway, but that didn't keep pharmacists and beneficiaries from heading to Capitol Hill on Friday to relay their frustrations with the rocky start of the Medicare drug benefit.
At a briefing sponsored by California Democrat Rep. Henry A. Waxman, the American Pharmacists Association called the startup "a fiasco." Pharmacists can't go on much longer giving out free drugs and spending hours every day on the phone to determine eligibility, said Tim Tucker, a Huntingdon, Tenn., pharmacist who spoke on behalf of the association.
Beneficiaries relayed their frustration of spending hours on the phone trying in vain to assure drug coverage. "I do not know who is the clone of FEMA Director Michael Brown who botched this job at Medicare, but this is yet another person who should be fired," said Ruth Grunberg of Cortland, N.Y.
Vivian Barrett, a Medicare beneficiary from Lorton, Va., said the CEO of her drug plan "got a whole bunch of money from y'all—for what?" Congress should cut off payments to plans at the end of the month if they don't get seniors their drugs, she lectured Waxman.
But a CMS spokesman, who billed the briefing as a partisan event, said the startup has been smooth for the most part. "While there are some pharmacists who are having problems, there are many pharmacists who are able to access the systems and to make sure people get their prescriptions," said Gary Karr.
"While we are having problems with a few thousand people in a program that's covering 24 million people, we are working very hard to make sure that everyone who has coverage can get it," he said.
Karr added, "It is disappointing to see this level of partisan politics enter the equation."
Pharmacy Woes
Marlene Brantley, a pharmacist in Lafayette, La., said she and her colleagues worked overtime in the aftermath of Hurricane Katrina to ensure that evacuees got their drugs. But that "seemed like a walk in the park because this situation is dire," she said.
The confusion is intensified by the high number of plans and the inability of pharmacists to establish eligibility under various plans. And it's even worse in nursing homes, she said, where residents have been randomly assigned a plan without regard to whether it covers their medications.
Brantley said her small pharmacy has been supplying a local nursing home with drugs without receiving payment, spending thousands of dollars it doesn't expect to recover. Many of the home's residents are eligible for both Medicare and Medicaid—a population in which eligibility has been particularly hard to document in the early days of the drug benefit.
"If we don't see help, I see all of us throwing up our hands and quitting," Brantley said.
The American Society of Consultant Pharmacists is predicting "chaos" in long-term care if problems with the drug benefit aren't quickly fixed. (See related story in this issue.)
But Karr of CMS said the problems in nursing homes aren't widespread. "The expression we are hearing from nursing homes is generally very positive, but that doesn't mean people aren't having problems. Some have prepared very early for the transition and they are having even fewer problems."
Tucker, the American Pharmacists Association representative, recounted similar concerns about the costs of helping Medicare beneficiaries, although he primarily blames prescription drug plans for the early foul-ups.
Recent statements by Medicare officials that "'no one should leave the pharmacy without their medications' are not helpful, particularly when some pharmacies have reported up to $40,000 in outstanding receipts," Tucker said.
Stephen W. Schondelmeyer, a pharmacy professor and researcher at the University of Minnesota, said: "This situation has already caused economic harm to community pharmacies and the longer it continues, the more severe the impact will be."
The Phone Trail
Ruth Grunberg said she took her drug plan's insurance card to the local pharmacy on Jan. 1 and then spent much of the following nine days fruitlessly trying to get her prescriptions filled.
She said she called her drug plan, Medicare, a local newspaper reporter assigned to her story, the local congressman and two U.S. senators, AARP, a Syracuse TV station, the Office of Aging, Families USA, Consumers Union, the Better Business Bureau, the state insurance commissioner's office, the county board of health, and the New York Attorney General's office.
After nine days her card was recognized and all but one of her nine prescriptions were filled. "I learned that insurance companies had the right to change what they covered at any time, but not until February. So the denial was illegal," Grunberg said. "But I still could not reach anyone to solve the problem."
"It dawned on me that if I could not find the solution, what was happening to those more elderly, more confused, or less informed?" Grunberg said that when she called her congressman about the issue, she learned he was in Antarctica. "Perhaps a Congress in session, not in recess, could have been more help to millions of people victimized by their own government."