Medicare D: A Prescription for Confusion--Part II - WTOC-TV: Savannah, Beaufort, SC, News, Weather & Sports

02/14/06

Medicare D: A Prescription for Confusion--Part II

It's supposed to save you money, maybe half your prescription costs. But the new Medicare program has lots of problems. Many senior citizens and even their pharmacists have had it.

Seniors have been denied their medications at pharmacies, and some are paying double what they normally do. That's if they make it to the pharmacy. Some can't even get through all the paperwork to sign up.

They're upset, they're frustrated, and with so many choices, many seniors don't know which plan to pick. While the plan is supposed to help seniors save money, it's not saving them the hassle elsewhere.

Edith Stanley of Bluffton knew the Medicare prescription plan was just what she and her husband, Frank, needed to help pay for their medications.

"We had no prescription insurance to cover our drugs, and we've both had some problems, so we were like, 'Oh great! For $28 a month, we're going to be able to get these at a better price!'" she told us.

So Edith did her research. In October, she sat down and compared the new prescription drug plans, by going to the Medicare website and typing in all the medications she and her husband take. She found a match with the AARP plan. Their list had 96 out of the 100 drugs covered on Medicare's list, including a hormone replacement drug Edith uses daily.

"I was pleased," she said. "I printed out a printout on October 31 that said that. We decided they were going to work best for us, so we filled out the forms and sent them in. And we got our cards back."

Believing she was ahead of schedule, Edith never gave another thought about it until she went to use the card for the first time at her pharmacy this past January. That's when she ran in to problems. The pharmacist told her the drug she so desperately needed was not on the list anymore.

"The pharmacist said, 'I don't understand it myself, because it was on the database yesterday. Today, it's not.' So somewhere between January 3 and 4, it was removed."

Edith was forced to pay for her meds out of pocket. When she tried to call Medicare, she got no answers about the mix-up. "I've called three times, and they continue to tell me it's not covered and will not be covered, nor is the generic covered. My only alternative is to order it myself and pay for it myself."

Costing her twice as much as what she would have paid if it was covered on the plan.

And she's not the only one having problems at the pharmacy counter. Pharmacist John McKinnon of Low Cost Pharmacy on Abercorn Street in Savannah says their systems have been overloaded since the Medicare plan took effect in January.

"I've been practicing pharmacy since 1979, and the first two weeks of January were the worst two weeks in my professional career," he told us.

McKinnon has seen firsthand all the problems his customers have had since the prescription cards took effect, everything from their co-pays not being right to not being in the system at all to finding out, as Edith did, their life-saving drugs aren't covered by their plan anymore.

Each issue requires a phone call to Medicare, but getting through to a representative has been frustrating. Pharmacists have been stuck on hold, waiting to talk to someone for hours--sometimes days--and that's just for one customer.

"When we can't get an instant answer and instantly solve a person's problem," said McKinnon, "you can't keep moving efficiently in day-to-day operations. You're getting roadblocks. And even though you overcome them at some point, it's affected everything else."

Some senior citizens don't even make it to the pharmacy. They're still stuck in all the paperwork. Robert Moore of Savannah, 75, says he can't make heads or tails of all the different prescription plan choices.

"I don't understand it, frankly, and I haven't talked to anyone who does, including my pharmacist," he said.

After sifting through all the information on the internet, Moore gave up and ended up going with the Medicare AARP prescription drug plan, only because he was already a member of the organization.

"It was the simple thing to do," he said. "It may not be the best, but there is no way anyone can decide which is the best. At least, not at my age." 

Some believe there are just too many choices. In the State of Georgia, there are 54 Medicare prescription drug plans to choose from. In South Carolina, there are twice as many choices. Each plan doesn't cover every drug, and each pharmacy doesn't accept every Medicare plan, confusing everyone.

Most seniors didn't realize the program was so complicated until the plans took effect at the beginning of this year, creating havoc for themselves and pharmacists.

"Since a lot of them didn't have their cards yet, it created a backlog for third parties, leaving everyone else to figure out who to bill, and what was the proper way to bill them," said pharmacist Lou Scavo.

Medicare advisors urge seniors to do their research, like Edith did, before making a decision. The more senior citizens know, the less chance they have of choosing the wrong plan.

"They need to be cautious, don't rush in to anything," advised Tim Rutherford with Senior Citizens, Inc. "They need to get some advice on what they should do. They can even talk to their pharmacists about that."

And there are a lot of people in the Coastal Empire and Low Country who haven't picked a plan yet.

If you're interested in signing up for a plan, and want to know more about your options, there is a website you can go to to compare all the plans: www.medicare.gov.

Or if you've signed up and have some questions or problems with your plan, you can call the Medicare hotline, which is 1-800- MEDICARE.

If you're still confused--and many people are--coming up tomorrow, we'll show you some other options, including face-to-face counseling sessions, and something as simple as talking with your pharmacist to help you decide which prescription plan is right for you, if you need it at all.

So what should seniors do if they get the pharmacy and find out their prescriptions aren't covered? Both pharmacists we talked with, and Congressman Jack Kingston, have made it clear that no one should leave without their medications. It's up to the pharmacist as to how they want to handle it. Most will have you pay, then and reimburse you later, but no one should leave without getting their prescriptions.

Also, if you find out, as Edith did, the pills will not be covered, you can ask your doctor to write an appeal to Medicare, asking them to make a special consideration to cover the medication. But that's on a case-by-case basis and there's no garauntee they'll change their plans.

Reported by: Melanie Ruberti, mruberti@wtoc.com

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