A few glitches on opening days of Medicare Part D drug plan

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Some pharmacists and consumer advocates said there were plenty of glitches during the opening days of the Medicare prescription drug benefit, while others argued the problems were relatively few considering the size of the new Part D program.

"It's your typical Jan. 1 glitches -- they're getting worked out," Michele Vilaret, director of government programs for Eckerd stores, said yesterday. "Most of the world changes insurance the first of the year, so it's always havoc in a pharmacy. We've just compounded it with Medicare."

Ms. Vilaret said some pharmacies operated by Eckerd's parent company initially had problems getting approval to fill 30-day prescriptions through Medco Health Solutions Inc., a New Jersey-based pharmacy benefit manager.

Locally, Medco works with Highmark Inc., so several Pennsylvania pharmacists reported similar problems, said Pat Epple, executive director of the Pennsylvania Pharmacists Association. Some patients wound up going home without their medicine because of the situation, Ms. Epple said, although she stressed that no patients were put in jeopardy.

A Medco spokesman did not return a call seeking comment, and Highmark spokeswoman Denise Grabner said the insurer knew of no significant problems related to Part D. Noting that Highmark members have successfully filled more than 20,000 prescriptions through the new Medicare drug program, Ms. Grabner commented: "It's gone relatively smoothly."

Ms. Vilaret, the Eckerd official, said initial problems with a computer system to check the coverage status of people enrolled in both Medicare and Medicaid largely were resolved by yesterday. But consumer advocates said many of these patients, known as "dual-eligibles," still were having troubles.

Dual eligibles had the option of choosing a plan providing Part D coverage or being automatically assigned to one. As part of the transition to the new Medicare program, some dual-eligible patients in the urban areas of the state have been switched into health plans with limited networks of doctors and hospitals.

While federal officials have taken a variety of steps to ensure that dual eligibles will continue to get the drugs they need -- including allowing them to change Part D plans at any time, Alissa Halperin, managing attorney with the Pennsylvania Health Law Project, said, "We have people who are due to start chemotherapy tomorrow and the hospital suddenly isn't in their network."

Jack Vogelsong, director of the state's Apprise health insurance counseling program, added: "We have a number of cases that are sitting on my desk where the patient came home from the pharmacy without their prescriptions. They seem to involve more of the dual-eligible population at this point, but it could be that that population is just more familiar with our service."

Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412 263-2625.


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