Help for
Caregivers

Press Release -- January 6, 2006

Prescription Drug Coverage Helping Individuals Who Are Experiencing Problems

Denver, CO. Many Medicare beneficiaries have either voluntarily signed up or were signed up by Medicaid or their HMO for the Medicare Part D benefit effective January 1, 2006.

Pharmacists, physicians, and seniors alike have been awestruck by the difficulty they are experiencing in getting their medications filled. Mark McClellan, Centers for Medicare and Medicaid, recently ordered the prescription drug plans to "pay" for drugs of persons who have had problems with processing of paperwork. However, that remedy has only been somewhat helpful, since the retail pharmacies such as King Soopers are having problems confirming eligibility.

Further complicating the problem is the fact that corporate policy for the retail pharmacies such as King Soopers is that they will not fill the prescriptions if they don't have a confirmed "payor source", regardless of Dr. McClellan's order, causing many people to leave the pharmacy without their medications or having to pay significant out of pocket costs.

According to Medicare, individuals who enrolled in Medicare Part D should receive an acknowledgment in about a week, followed by an ID card within 3-5 weeks.

If individuals did not receive an ID card and need to buy drugs immediately, they may present their acknowledgment letter from the plan (or the confirmation number from an internet enrollment, but again sometimes the plans do have these confirmation numbers), and a Medicare and/or Medicaid card and a photo ID. Individuals who pay privately should save the receipts in case questions arise at a later time.
Prior to going to the pharmacy, contact the plan to see if you are enrolled in the plan. It is easier to wait for a confirmation that you are listed with the pharmacy in the comfort of your home, rather than at the pharmacy.

Those experiencing the most problems are dual Medicare and Medicaid beneficiaries and those who believe they are eligible for the "extra help". Much of the problem lies in the completion of the form to apply for "extra help". For individuals who should have been enrolled in or applied for extra help and who did not receive notification on eligibility, one suggestion is to re-enroll in the program via the internet. Although many seniors are not internet savvy, this approach seems to work the best. Individuals needing help to apply should call 1-888-696-7213 and ask a counselor to help you. Although these counselors may not help you directly, they have special numbers to contact Social Security and Medicare to ascertain problems with your application for "extra help" and "enrollment", as well as Medicare/Medicaid questions.

Individuals who were auto-enrolled in a plan because they are receiving both Medicare and Medicaid, should have received a "yellow letter" with the name of the company to which they were assigned. Many people either did not receive or do not remember receiving the "yellow letter". Since Medicare/Medicaid beneficiaries can change plans each month, one suggestion is to call 1-888-696-7213 for assistance in enrolling in a plan that meets the individual's current needs, rather than trying to determine to which plan they were automatically assigned. This process can also be beneficial, as the individual can select the prescription drug plan that best meets their current medication needs.

Another problem that individuals are encountering who are both Medicare and Medicaid eligible is that the plan does not cover all or most of their prescriptions. Therefore, these individuals should switch plans to get better coverage.

Seniors who enrolled or thought they were enrolled are most frustrated because until the individual goes to the pharmacy, they are unable to confirm whether they are registered on the computer system to receive their prescriptions under the Medicare Part D benefit.

Estimates vary, but some pharmacists are reporting that as many as 75% or more of the individuals who thought they were covered are not registered on the computer system. In this situation, individuals must prove they are covered by providing a copy of the application form, a Medicare and/or Medicaid card and an ID card.
Although Medicare ordered the prescription drug plans to cover a 30-day supply of the medication, this only applies to individuals who are listed on the registry that is used by the pharmacy. Other individuals are being charged full price or they are not having the prescriptions filled.

For more information with selection of a plan or enrollment assistance, call 303-333-3482.