Start of Medicare Drug Plan Sees Successes and Struggles

[papau]

http://www.nytimes.com/2006/01/03/politics/03drug.html

Start of Medicare Drug Plan Sees Successes and Struggles

By ROBERT PEAR

WASHINGTON, Jan. 2 - Some Medicare beneficiaries were pleasantly surprised and saved money, but others were frustrated this week as the prescription drug benefit got off to an uneven start across the country.
People who applied early and had identification cards in hand were often able to fill prescriptions through the new program, the most significant expansion of Medicare since its creation 40 years ago. But others were stymied in their efforts to take advantage of the drug benefit, as pharmacists spent hours trying to confirm eligibility and enrollment by telephone and computer.<snip>
In Brooklyn, Seth Kaplan, a 36-year-old disabled Medicare recipient, reported a very different experience. He said he had struggled unsuccessfully to get his drug plan to pay for his asthma medication. He said that he and his pharmacist had spent two hours on the phone with the insurer, WellCare, and that he eventually had to pay for the drug with his credit card, at a cost of $191.<snip>
A Medicare drug plan typically has a list of covered drugs, known as a formulary. Under Medicare rules, each plan is supposed to have a transition policy, providing a "one-time fill" of any prescription excluded from the formulary, so doctors can prescribe another drug or challenge the denial of coverage.<snip>

[William769]

1. It has been pure hell for us!

We were on medicaid & eligable for assistance, medicaid says we are, Social Security says we are & Medicare says we ar. the only problem is no one has let our insurance company know. & they asll say it's somebody elses problem to do the notification.

Bottom line between the two of us, our copays is 6,900 a month (you read that correctly), we are both on Social Security, do the math. :mad: :mad: :mad:

[papau]

2. WOW - I thought mine were bad . You are one of the few that might

actually benefit from a plan that limits your drug outlays to less than $4000 a year each.

[William769]

3. I don't know.

I am so confused right now & our medicines are for life threating causes (what I mean is not just for health maintenance).

[papau]

4. Do you want me to get you in touch with some help on this?

I'd be glad to do so.

:-)

[William769]

5. Any help would be greatly appreciated.

Thanks.