Government: Medicare Snafus Improving, But Future Problems Expected

Bush administration officials said Tuesday that problems plaguing the first month of the Medicare prescription benefit are improving but warned patients and health providers to brace for more.

Hundreds of thousands of patients using their Medicare drug benefits for the first time have reportedly been unable to fill needed prescriptions at pharmacies. The problems have affected mostly poorer patients who previously used Medicaid to obtain medicines but were switched to the new Medicare program on Jan. 1.

Most of the problems were caused by poorly updated computer systems that did not contain beneficiaries’ files when they went to buy medicines. Pharmacists and patients who ran into trouble were confronted with long waits as call centers run by private Medicare drug plans were overwhelmed with requests for help.

Emergency Aid

The breakdowns forced 22 states and the District of Columbia to step in with emergency aid to cover beneficiaries’ drug costs.

They also sent federal officials scrambling to unravel problems affecting 600,000 or more beneficiaries.

Health and Human Services Secretary Michael O. Leavitt described the transition for the new benefit, which is less than a month old, as having “still plenty of bumps, but much better” than it was last week.

He said that health plan call centers have improved their wait times and that government and health plan computers are communicating more effectively with terminals pharmacists use to verify patients’ benefits before dispensing medicines.

“We are taking it seriously and we are doing everything we can,” he told reporters Tuesday.

Leavitt this week completed an eight-state trip during which federal officials met with state officials and health providers confronting problems implementing the new benefit. He is set to leave Wednesday to visit seven more states.

New Problems Anticipated

But Leavitt also repeated warnings that despite government efforts, problems could re-emerge after plans and pharmacies start a new billing cycle Feb. 1. Patients who enroll in drug plans at the end of this month could find that pharmacy computers don’t contain their files early next month.

“We anticipate that there will be problems on Feb. 1 with people who enrolled or switched their plans late in the month,” he said.

Leavitt urged seniors signing up for a drug plan or switching to a new plan from an assigned Medicare plan to do so early in the month. “The sooner you do it in the month, the more likely it is that the system will reflect that change when you go to the pharmacy counter at the end of the month,” he said.

Reimbursement Plan

Medicare officials announced a plan to ensure that the federal government and private companies will pay states back for millions of dollars they’ve spent providing emergency drugs to beneficiaries. The government is also investigating some drug plans for refusing to provide some promised drugs in the plan’s first month, Leavitt said.

Leavitt said he was “not prepared to quantify” how many plans are under investigation.

Medicare director Mark McClellan, MD, said the federal government expects states to stop the emergency funds no later than Feb. 15 so that the government can take over.

Many pharmacists have complained that they have not yet received payments for some prescriptions filled in January. John Rector, chief counsel for the National Community Pharmacists Association, tells WebMD that his group has been “pleading” with drug wholesalers and manufacturers to extend grace periods for payments on medication shipments now coming due.

“The pharmacies are not being paid. They’ll be out of business if they’re not paid,” he said.

By Todd Zwillich, reviewed by Louise Chang, MD

SOURCES: Michael O. Leavitt, secretary, Health and Human Services. Mark McClellan, administrator, Centers for Medicare and Medicaid Services. John Rector, counsel, National Community Pharmacists Association.