April 1st will be a new danger point for many seniors on Medicare D.

[madfloridian]

Things have been bad enough for many since the program started. A program may cover one drug and not another, seniors too old and tired to stay on the phone for hours give up. Lots more. Pharmacies have gone broke from providing life sustaining medicines to those who for some reason aren't getting what they need.

No one is talking about it on TV. There is little discussion of it at all in public arenas. Someone has to talk about it on the air, someone has to make a fuss for the sake of these people who will be involved. It is a sin not to do so.

On April 1st it gets much worse. Almost unbelievably worse. On that date insurers can just say they won't pay for a certain drug which is not on their list.

http://www.wtol.com/Global/story.asp?S=4651504

WASHINGTON (AP) -- Many elderly and disabled Americans enrolled in the Medicare drug benefit will face new difficulties obtaining their medicines on April 1st, say advocacy groups familiar with the program. On that date, insurers will have more latitude to tell pharmacists they won't pay for a particular drug. Before that, insurers have been told they should pay for a prescription even if it's not on the list of drugs they cover.

"I think that, after April 1st, you're going to see huge problems with access. It's going to be January 1st all over again," said TomClark, policy director at the American Society of Consultant Pharmacists. The association represents pharmacists who serve nursing homes.

And this part sounds reassuring, doesn't it? The very poorest can either switch plans or get access to "substitute medicine." Oh, you ask, who gets to decide that "substitute medicine." And will it work? How long will it take to tell if it will work? Will there be side effects? So many questions.

Government officials said the Medicare drug benefit covers most of the drugs commonly used by seniors and the disabled. They say beneficiaries who take those drugs will have nothing to worry about come April 1st. And, if beneficiaries find their drugs aren't on a plan's list of covered drugs, often referred to as the formulary, they usually will have access to substitute medicines. The poorest beneficiaries can switch plans at any time.

"What we're requiring is that the formularies all must be broad, all must meet our stricter-than-usual requirements, plus there must be a timely way for beneficiaries to get an exception," said Mark McClellan, head of the Centers for Medicare and Medicaid Services.

I will be posting more later, including a press release from Henry Waxman about "step therapy." Now there's a great concept for the very ill and disabled.

Seniors are hurting now. Many are just too tired and confused to handle things like this. We try to help when we can do so, but too many are slipping under the radar. This should not be happening in our country.

Also I saw a list of drugs that will be involved in the "step therapy". It is alarming. I will find that again also.

By not calling attention to all of this loudly, our party is letting our seniors down. I expected the Republicans to let them down...they just don't care. I did not expect it of our own. Maybe I just missed all the times they have talked about it.

[graywarrior]

1. Thanks for posting this.

[Sal Minella]

2. Yes. Thank you.

[madfloridian]

3. Waxman speaks out on lack of disclosure of possible dangers in program.

And a press release from Henry Waxman.
http://www.commondreams.org/news2006/0323-05.htm

Based on a Medicare database, a phone survey of Medicare drug plans conducted in Rep. Waxman's congressional district, and the Medicare.gov website available to seniors, the report finds that the use of prior authorization requirements, step-therapy provisions, and volume limits by the Medicare drug plans is widespread, but disclosure of their terms is virtually nonexistent.

Specifically, the report finds:

Prior authorization requirements, step-therapy provisions, and volume limits by the vast majority of Medicare drug plans restrict access to formulary drugs. The Medicare data show that 97% of plans place either prior authorization or step therapy requirements on at least one of the 100 most popular drugs, with the average plan restricting access to over 10% of the popular drugs listed in its formulary.

Medicare drug plans are unable to describe plan restrictions accurately. Over two-thirds of the Medicare drug plans contacted in the phone survey were unable to describe accurately how the prior approval, step therapy, or volume limits worked with their particular plan.

Medicare drug plans provide erroneous or conflicting information about restrictions. A number of Medicare drug plans provided information that was erroneous or misleading or conflicted with other information provided by the plan in the phone survey.

The Medicare website and the websites of plan sponsors fail to provide adequate information about restrictions. Seniors cannot rely on the Medicare.gov website or the websites of plan sponsors to inform themselves about the details of plan restrictions. The report is available online at www.democrats.reform.house.gov/ or may be emailed upon request.

###

It is my understanding that many of these restrictions refer to PDPs, but not sure about that. I understand they cover the people who are Medicaid...now Medicare D.

"Prescription drug plan (PDP):
Step-Therapy:

A requirement by the PDP that a person must try one medication before the
doctor may prescribe another, more expensive one.


A private drug company. Medicare will assign every person who receives both
Medicare and Medicaid to a PDP. Each PDP will have its own list of approved
drugs and its own drug stores. The monthly cost you pay will be different
depending on the PDP you pick. You can change your PDP if you want to."

[GrumpyGreg]

4. What is step therapy?

[madfloridian]

6. Scary stuff.

Step-Therapy:

A requirement by the PDP that a person must try one medication before the
doctor may prescribe another, more expensive one.

[GrumpyGreg]

8. God almighty,what a damned fiasco this thing is.

You could die trying out the cheaper drug.

I'm a senior who fortunately doesn't need this coverage since I have private coverage from my ex-employer but the way things are today they could cancel it anytime.

I think Bush and the gang just want us old folks to shoot ourselves in frustration.

[madfloridian]

10. Yes, one could die trying an alternative drug.

It is horrible stuff.

[madfloridian]

5. More of what is happening to seniors right now. Can't wait too long.

Many people just can not wait for someone to start making waves publicly and nationally. Some just can't wait that long.

Letter to the editor, Sun Sentinel:

http://www.sun-sentinel.com/news/opinion/letters/sfl-pbmail714xmar27,0,1857243.story?coll=sfla-news-letters

"Prior to this year, I received a medication that enabled me to cease receiving disability assistance and return to work as a taxpayer. Now, my medication has a copay that is almost as high as my mortgage.

I won't be able to receive medical care and will soon return to the physical state that caused my being disabled. If I were Canadian or European, I could probably find affordable medical care, but being American, it has been ensured that those options are closed to me. Additionally, financial assistance programs that used to exist are no longer available because of the new plan."

And another article.
One plan may cover drugs not covered by another.

"Thousands of seniors and other citizens who rely on prescription drugs say the sheer number of options is too confusing. In some cases, plans even deny people the very drugs that prompted them to initially enroll.

"Why can one plan cover certain drugs and another plan not cover those drugs?" asked Conklin, a former vice president of the Rochester TA. Some people, especially those eligible for Medicaid and Medicare, complain of payments increasing as benefits decrease and losing access to drugs that were once covered.

For many, Macek said, the plan is too expensive. "To get to the catastrophic illness phase where it covers 95 percent of your drugs, you may have to spend up to $3,600 a year out of pocket. It's not really affordable when you finish with your deductible and premiums."

http://www.nysut.org/newyorkteacher/2005-2006/060330r_medicare.html

[MikeStl]

7. So I guess

This is the governments idea of an April fools day prank :eyes: :shrug:

[madfloridian]

9. A plan has been put forth by Kennedy and Stabenow....

But our most outspoken Democrats need to be front and center talking about this out loud on TV. I just learned about the program, and I get mail from Kennedy often. So the first step is publicizing it.

While we are waiting for the GOP to deconstruct on this issue, some seniors will give up in despair and not bother to take their medicine. I have had some cry when I talked to them, and I found myself in tears trying to figure out some problems for a friend.

http://www.tedkennedy.com/content/708/the-medicare-guaranteed-prescription-drug-act

"Gives every Medicare beneficiary the choice of receiving their drug benefit through traditional Medicare, with a formulary that is not allowed to change from day to day or state to state.

Allows Medicare to negotiate the same good discounts on drug prices that the VA gets for veterans.

Establishes a consistent nationwide premium for Medicare drug coverage.

Reduces the annual deductible for drug coverage.

Increases the share of seniors' drug costs that Medicare will pay.

Eliminates the so-called "doughnut hole" that will force seniors to bear the full costs of their drugs one a minimum is reached.

Provides true security against runaway costs by assuming the full costs of drug purchases once a maximum out of pocket spending limit is reached."

Can you imagine how many seniors we would win over by going on the air and making a big deal of this? Having photo ops about this? Can you imagine.

[pacalo]

11. OMG. Thanks for this!

I'm concerned about my mom's medication. Even with Medicare, she's having to pay around $3-400 a month. I have a feeling some of her medication would be dismissed because they're for her nerves rather than for life-saving purposes. Knowing how dispassionate this administration's policies for the non-rich are, I'm worried.

Do you have a link for the list of drugs that will be affected?

[madfloridian]

12. I did have it, trying to find it now.

I don't have the exact concept for the list...so let me say I am not sure.

[madfloridian]

13. I found this diary, and get mixed signals.

I can not figure out if it is a generic thing within these categories...and I don't know if it includes all of the drugs within a category.

I know Florida had some controversy about not covering all the drugs for those with mental/emotional problems. I heard they fixed it sort of, but not sure. It appears to affect the PDPs only...Medicaid to Medicare D.. but not sure.

http://www.dailykos.com/story/2005/11/7/20755/8453

I just can't vouch for the accuracy of the list, but I know I saw an article with a similar one. Will check tomorrow. Diary is from November, so may be out of date.

[pacalo]

15. Thanks, madfloridian. It's sad that we have to dig for the information

isn't it? I'm so tired of the media walking on eggshells to avoid making this administration & his enablers in congress look as bad as they truly are.

[KT2000]

14. This is dangerous

I take a drug for arrythmia that works OK. Then the pharmacy gave me another brand and I went into serious arrythmia. Since it was a holiday weekend, I had to quit taking the meds all together. Quitting suddenly and taking the bad meds had the ame effect.
This is really something they should not be playing around with, unless their goal is to murder people. I think it is.

[Karenina]

17. A legitimate question

to which we will never get an answer is, HOW MANY PEOPLE HAVE ALREADY DIED FROM THIS FIASCO? Who needs boxcars and IBM calculators when killing people off can be accomplished by "incompetent" (for plausible deniability) policy? No nasty pictures, documentation or accountability.

[area51]

21. "... unless their goal is to murder people."

Truly, I believe that is their goal.

[madfloridian]

16. Several more articles about this dangerous plan.

And it is indeed dangerous. It is not only dangerous to seniors, but to pharmacists. It should be a huge photo op for our Democrats. I really don't believe a lot of them understand just how bad it really is.

http://www.themonitor.com/PrintIt.cfm?Template=/GlobalTemplates/Details.cfm&StoryID=12270&Section=Local

Medicare D kinks taking toll on area’s independent pharmacies
March 28, 2006
Jennifer C. Smith
The Monitor

EDINBURG — Each day’s passing brings pharmacist John P. Calvillo hope a $200,000 check will arrive in the mail.

"Yeah, we are hurting financially," said the partner in Cornerstone Pharmacy in Edinburg. He is awaiting drug reimbursements from insurance companies participating in the new Medicare drug prescription benefit.
Local small, independent pharmacies — outside the large drug chains such as Wal-Mart or Walgreens — agree with other pharmacy operators nationwide who say the Medicare program is hurting their customers, as well as their business.

"It’s taken time away for our patients, and that’s the worst thing that could have happened," said Danny Vela, co-owner and pharmacist at Lee’s Pharmacy in South McAllen.

"Patients are not given what they deserve in terms of health care," he said. "Sometimes they wait longer because the insurance has to be cleared or verified."

http://www.madison.com/tct/news/index.php?ntid=76105&ntpid=6

State to battle Medicare D fraud
AG, coalition join to help senior citizens
By Anita Weier

The state attorney general and the Coalition of Wisconsin Aging Groups today announced a "Medicare D Watch" effort to combat fraudulent practices and coverage problems affecting senior citizens regarding the new federal prescription drug program.

"We are running into significant problems with confusion, deception and some outright illegal activity," said Helen Marks Dicks, executive director of the Elder Law Center.

"There is a scam going on now where someone calls and says they will sign you up. They get your Social Security number and credit card number and charge $299, and you get nothing."

CWAG has received 5,000 calls on its helpline with questions and complaints from the beginning of October to mid-February, she said.

http://www.latimes.com/news/printedition/california/la-me-medicare27mar27,1,5397279,print.story?coll=la-headlines-pe-california

Drug Plan Doesn't Speak Their Language
Seniors with limited English skills are having a hard time accessing Medicare's new prescription program.
By Rong-Gong Lin II
Times Staff Writer

March 27, 2006

More than a month had gone by, and 81-year-old Lee Sun Hua still didn't have his medication.

In January, a pharmacist had refused to give the Koreatown resident his drugs, erroneously telling Lee he needed his new Medicare drug prescription card. He waited for weeks, and even had a volunteer at a Koreatown nonprofit agency call to request it. But it never came.

Bothered by a chronic stomach ailment, Lee called his Medicare drug plan provider, Blue Cross, two weeks ago to inquire again.

"I don't speak English," he said, reading from a tip sheet prepared by the nonprofit, which spelled out the pronunciation of English phrases using Korean syllables. "Korean, please."

"We don't have any Korean speakers here," came the blunt response, as Lee recalled the conversation. "Does anyone over there speak English?"

If native English speakers are having trouble grasping the new Medicare prescription drug plan, many immigrants with little or no English ability are far worse off. As the May 15 deadline for picking a plan approaches, elderly immigrants are swamping clinics, community centers and pharmacies, unable to read the litany of Medicare-related mailings and or even ask questions about their new plans.

[madfloridian]

18. Falling into the "doughnut hole"....coverage gap hurting seniors.

Saturday is the first of April, and I wonder how many will get a shock over the week-end by not being able to get their medication. I find myself in disbelief that those who were on Medicaid before will have to navigate through this mess, especially that huge coverage gap.

I am finding it hard to get info on whether some will not have to pay that huge amount. Medicaid patients did not have to before, and I hope they don't have to now.

http://www.capecodonline.com/cctimes/seniorsfalling29.htm

Seniors falling fast into Medicare drug plan gap
By ROBIN LORD
STAFF WRITER

Ken Kipnes thought he had planned it right when he signed up for a Medicare Part D drug plan earlier this year. His figures showed that he would get through the year without falling into the so-called ''doughnut hole,'' where plan coverage drops off and a member has to spend $2,850 out of pocket before it picks up again

He was stunned to learn last week that he had misunderstood the way the system works and will have to spend more than he thought on his prescriptions this year.

''I'm absolutely in shock,'' he said last week.

Under the new law, which went into effect Jan. 1, Medicare recipients can sign up for a prescription plan from a private insurance company. In Massachusetts, there are about 45 plans available.

Plan members pay a monthly fee and a co-payment for their drugs. Most plans also have a deductible.

After co-payments, the plan pays the rest of the cost of drugs until the total reaches $2,250. From there - the start of the ''doughnut hole'' - the member pays the entire cost of prescription drugs up to the limit on the other side of the gap, $5,100.

[Doctor_J]

19. SO when our *-voting parents can't get meds any more,

do we help them out, or tell them the truth - "You fucked up and voted for these criminals - good luck!"

[madfloridian]

20. 20 million of the 25 million enrolled so far already had drug benefits...

apparently, through Medicaid or other providers. Some county plans kept their program going, but I think they had to get permission to do so....trying to verify that. I think they got a subsidy for doing so. Like the retired county workers here.

I wonder what the break down is on just Medicaid being forced to switch to this horrible plan. Those who can least afford the doughnut hole.

http://content.nejm.org/cgi/content/full/354/13/1339

Part "D" for "Defective" — The Medicare Drug-Benefit Chaos

"True, the program provides drug benefits for some Americans who previously had none. But because of its strange design, enrollment is falling far short of expectations. Officials in the Bush administration boasted that 25 million people are receiving benefits through Medicare Part D. But the government's data reveal that about 20 million of them already had adequate drug coverage through Medicaid, their employers or unions, or health maintenance organizations; as of late February, the new benefit was providing only 12 percent of the elderly with coverage they did not already have.1

In many cases, the program worsened patients' situations, with a particularly heavy burden falling on indigent Medicaid enrollees. Before the new entitlement, most had virtually all their medications covered fully by the states. But on January 1, 6.2 million of these vulnerable elderly were reassigned to one of the private insurance companies designated by Medicare to run its program. Word of these arrangements didn't always reach the patients, insurers, or pharmacies accurately, and tens of thousands of indigent patients were told to get prior authorization, pay a large initial deductible, or make substantial copayments for regularly used medicines they previously received at no cost.2 Thousands discovered that the drugs they had been taking for years were not covered by their new insurers. Clinical crises ensued, and 37 states had to provide emergency payments for frail citizens.3

Despite its youth, the Medicare drug benefit is already chronically ill. But with extensive rehabilitation, it could go on for years, albeit with impaired functional capacity. Debate continues over whether its early spasticity was caused by inept management of its birth or a genetic disorder present at its creation. Proponents of the first explanation suggest that Medicare and its private insurers were not ready for the millions of applicants and hundreds of millions of prescriptions that poured in early in January, in a flood that they were ill prepared to handle. The layer of insurance companies inserted into the process in the name of efficiency exacerbated the confusion. An administration and Congress guided by Ronald Reagan's principle that "government is not the solution to our problem; government is the problem" put his vision into practice in a chillingly convincing way."

[madfloridian]

22. Medicare chief spins this program.

http://www.ridgecrestca.com/articles/2006/04/02/news/news03.txt

On Friday morning, the Administrator of the Centers for Medicare and Medicaid Services Dr. Mark McClellan spoke at a live and telephone news conference regarding the current state of the Medicare Part D program.

McClellan, fresh from a senior enrollment event in Sterling Heights, Mich., said he had met with many seniors who were “quite satisfied” with Part D coverage and mentioned he had spoken to one woman who was saving $350 per month.

Registration for Part D is up to about 400,000 per week as the May 15 deadline approaches and McClellan said the “overwhelmingly” positive response included that the plan was “worth the effort” and most beneficiaries are urging other seniors to sign up.

There has been a 90 day transition period for those who signed up by January 1. For anyone signing up from now on, this block of time to adjust prescriptions appropriately to drugs actually offered by one’s chosen Part D option has been reduced to 30 days for those dealing with regular pharmacies but will remain at 90 days for those in institutional care or for those who experience a change in care — from hospital to hospice, for example.

The Third Way Democrats had a training session today on National Security. The DSCC had another press conference today to tell how they will win on National Security.

Who is speaking up for seniors?

[madfloridian]

23. This is privatizing Medicare.

Our seniors are hurting, frustrated, confused. This next step will not just the drug program, but the privatizing of the whole Medicares system.

Then the turning over of Social Security to private companies, saying they can handle it best.

This is wrong. Our Democrats are very busy advocating for national security, but not a word about Medicare D.

[madfloridian]

24. More on this...

http://www.blogforamerica.com/archives/007691.html

Wednesday, April 05, 2006

More Medicare Confusion
Once again, the Bush administration is sloppily trying to cover up for its incompetence, and Americans are, as usual, taking the brunt of the burden.

"Hundreds of thousands" of Medicare beneficiaries discovered last week that they would be dropped from one of two prescription drug plans that they had "accidentally" become enrolled in. Many people who had been enrolled in one drug plan were unknowingly switched to another when the Bush administration rolled out their "new and improved" prescription drug plan. The switch caused massive confusion at the expense of seniors, who were suddenly charged two premiums and billed improperly for other costs.

The Bush administration is sending notices to every effected senior, expecting all the trouble to be cleared up by May 1.

As if.

California Medicaid director Stan Rosenstein said he understood the need for people to be enrolled in only one plan, but he predicted that the change would be "very confusing" to beneficiaries. Over six million low-income people eligible for Medicaid and Medicare were assigned to Medicare drug plans selected at random by the federal government. But, because these plans did not cover the drugs they needed, many people selected other plans, or were placed in other plans by relatives, state officials or former employers, thus becoming enrolled in multiple plans. "We try to reach people in 12 languages," Rosenstein said, "and even then it's difficult."

"This mass disenrollment is fraught with a potential for trouble," pharmacy affairs coordinator for the governor of Maine Jude E. Walsh said. "It does not make sense to do it all at once."

And, as always, the Bush administration is going about their business dishonestly. For those beneficiaries who have been enrolled in two plans but only have knowledge of one, the administration encouraged insurers not to breathe a word of the mishaps. Rather, just "deactivate their pharmacy cards to prevent them from accessing plan benefits in the future."