Complex, confusing plan gets rocky start

At first, the new Medicare prescription drug plan looked fairly simple. Medicare recipients would choose an insurance plan that would provide needed medications, and if you signed up before Dec. 31, coverage would start Jan. 1.

It would be even easier for those also on Medicaid, as the government would automatically enroll them in a plan in time for the January start-up. But choosing a plan proved to be complex and confusing, and the New Year brought more problems with the new program.

As many as 14,000 Missourians have been left out of the automatic enrollment, and an untold number of those who signed up with insurance companies still had no coverage more than two weeks into January.

The Dec. 31 date did not give insurance companies enough time to process new clients and start coverage the following day, several area pharmacists said.

&#8220Several customers have letters or even an insurance card, but the company doesn’t have them in the data base yet,” said pharmacist Lisa Umfleet, who owns Parkland Apothecary in Desloge. &#8220It was a flawed system. There was just no way (to start by Jan. 1)!”

The problem has led Gov. Matt Blunt to demand action from the federal government. To provide temporary relief for some of the recipients who are both Medicare and Medicaid eligible, Blunt has directed the Department of Social Services to put them back on the Medicaid roll until the federal government corrects several problems within Part D.

&#8220I know the administration is aware of the challenges states are facing with this new program,” Blunt said in a press release written on Friday. &#8220But we must have assurance that those in need will not be ignored.”

The 43 million Medicare eligible senior citizens and disabled persons in the country – including about 884,000 in Missouri – have until May 15 to enroll in the prescription plan. Approximately 21 million people had signed up by mid-December, expecting coverage to begin on New Year’s Day.

&#8220In the last couple of weeks, there have been a lot of people who have not been activated in the system,” said Julie Berghaus, pharmacist in charge at Dicus Prescription Drugs Inc. in Farmington. &#8220I can’t say whether that is a problem on the Medicare end, with the insurance companies, or with people who sent their enrollment in Dec. 31 and thought they would be covered on Jan. 1.”

Berghaus advises those who were not automatically enrolled to call 1-800-Medicare to find out why. Their best move is to call an insurance company and sign up for a program.

Be prepared for a long wait, Umfleet added.

&#8220My technician was on the phone 1 hour and 42 minutes with one insurance agency before she reached a person,” she explained.

Prescription cards identify a person’s insurance company and specific plan. However, without a prescription card, it is very difficult for pharmacists to identify a customer’s insurance company or policy.

That makes it almost impossible to be reimbursed for the prescriptions pharmacies fill unless special measures are taken, said Dan Freund, head pharmacist at Medicap Pharmacy in Farmington.

&#8220There’s so much confusion because there are so many plans, and each plans have several levels,” Freund said. &#8220Many people don’t have their cards yet, so we don’t know what plan they have. It’s like a jigsaw puzzle without all the pieces.”

Freund said that for each customer without a card, he would have to contact every plan to find out which one insures that person. Not only is that inconvenient, but each inquiry to an agency costs the pharmacy a fee, he said.

Freund suggests that customers without insurance cards bring in their confirmation letters to help identify their prescription plan. Without verification of insurance, Medicap Pharmacy won’t fill prescriptions unless the customer pays cash, he added.

&#8220It’s been really hard to get people their medicine,” Freund said. &#8220It’s getting better than it was, but it’s still very challenging. I think it could have been handled a little better.”

Umfleet’s father was among those who were supposed to be enrolled automatically, but were not. He had to enroll in a plan on his own Jan. 2, and still is waiting for the coverage to kick in, Umfleet said on Monday.

She has provided essential prescriptions to her father and other customers in the same situation, at her own cost. Umfleet said other pharmacists also are providing free supplies of medicines while their customers are waiting for insurance to kick in. Umfleet hopes that the state or federal government will reimburse pharmacists who do so.

&#8220There’s no guarantee that the state will reimburse for the free medicine,” she said. &#8220But I believe they will.”

Berghaus said that some plans provide a temporary card or short-term coverage for eligible people who are waiting to be entered into the system. While the responsibility lies on recipients to see that they are covered, pharmacists are trying to bridge the gap.

&#8220We as pharmacists are trying as hard as we can to see that nobody falls through the cracks, Berghaus said. &#8220We want to ensure everyone gets the benefits (he/she) deserve.