Eligibility Verification Problems Affect Medicare Drug Benefit Launch
Some Medicare beneficiaries who enrolled in the new drug benefit were unable to fill their prescriptions this week because of problems verifying their eligibility, pharmacists and advocates for seniors said, the Chicago Tribune reports.
Terri Gendel, director of benefits and advocacy at the Oak Park, Ill.-based Suburban Area Agency on Aging, said, "We are hearing that a lot of people are showing up at a lot of different pharmacies and are not walking out with their drugs. In some cases, they are being asked to pay inappropriate copayments."
As a result, advocates said, some beneficiaries have had to go without prescriptions for a day or more or pay for their medications out of pocket.
Pharmacies said some beneficiaries -- mostly dual eligibles -- were unable to fill their prescriptions because they had not yet received cards from their insurers verifying their eligibility. Other problems included busy help lines at health insurers and incorrect paperwork.
The government attributed the delays to the new verification system, which is run by government contractor NDCHealth, being overwhelmed.
Both the government and pharmacies said complaints of problems had slowed by Wednesday, and beneficiaries were receiving their medications.
NDCHealth said the initial problem in the verification system had been addressed. NDCHealth spokesperson Robert Borchert said that for most of the day on Tuesday, "queries were handled in less than a second."
CMS spokesperson Peter Ashkenaz noted that beneficiaries who enrolled in the drug benefit in late December also experienced some delays because of the large number of late enrollees.
Federal officials said beneficiaries who experienced a delay and had to pay out of pocket for drugs should keep track of their claims, so they can be reimbursed by their health plan (Japsen, Chicago Tribune, 1/5).
In related news, the Christian Science Monitor on Thursday profiled U.S. Comptroller General David Walker and examined his ongoing warnings about Medicare's financial problems. At the 2005 White House Conference on Aging, Walker warned of a "demographic tidal wave" of baby boomers and growth of entitlements -- such as Medicare -- that could result in a fiscal crisis for the U.S. According to the Monitor, Walker says if the U.S. is to address the situation, it must restructure Social Security, Medicare and Medicaid; limit the base of discretionary and other spending; and "look at tax policies" (Feldmann, Christian Science Monitor, 1/5).
The new Medicare drug benefit is not only a "long-overdue acknowledgement of the growing importance of drugs in health care," but also a "massive experiment in harnessing market forces -- consumer choice, market competition, private insurers, private drug makers -- to improve a big government-run, taxpayer-subsidized program," columnist David Wessel writes in a Wall Street Journal opinion piece. According to Wessel, the drug benefit has shown that "the market does sometimes work its magic," with a "plethora of providers" offering coverage under the new drug benefit.
However, he notes that the "market-friendly expansion of Medicare doesn't seem to be paying political dividends or attracting much consumer interest so far," possibly because the benefit "reflects political compromises that overlook lessons learned elsewhere about how consumers cope with an overwhelming array of choices." Wessel writes that the "next time politicians re-visit Medicare," they should remember that people are "not likely to choose" when options are "overwhelming"; more people will make choices if everyone in society is offered such choices and there is media attention; the government needs to develop a good option for those who cannot make their own choices; and do not make the choice look even more complicated than it actually is (Wessel, Wall Street Journal, 1/5).
Additional information about the Medicare drug benefit also is available online.