Not quite, but almost (Freking) perfect

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  • 01/04/2007
In case you missed.

(Of particular interest is that the Part D provider having the biggest problems -- at least according to one pharmacist -- is the AARP.)

Medicare drug benefit signup less bumpy this year
By Kevin Freking

WASHINGTON – Seniors are experiencing fewer problems at the start of the Medicare drug benefit's second year, even as hundreds of thousands come into the program for the first time or change plans.

The smoother start was reported Wednesday by federal health officials and representatives of seniors and pharmacists.

“It's not perfect, but it seems a lot better than last year,” said Carol Cooke, spokeswoman for the National Community Pharmacists Association, which represents about 24,000 pharmacies.

“It's nothing overwhelming like last year,” said Deane Beebe of the Medicare Rights Center. “But, yes, there is a smattering of problems we're hearing about. We've also spoken with pharmacists who say it's too soon to tell.”

With the start of a new year, hundreds of thousands of people are coming into the program for the first time, while hundreds of thousands more have switched insurance plans. The changes have the potential of causing havoc for consumers and health care providers if they weren't properly plugged into computer databases before Jan. 1.

The Centers for Medicare and Medicaid Services said it had seen nothing like the barrage of complaints that had marked the drug program's first week in 2006, when consumers were not listed in insurers' databases and pharmacists had problems verifying coverage.

“It's very quiet, but we're always on the lookout. There's nothing that has risen to the level of crisis,” said Jeff Nelligan, spokesman for the agency, which oversees the drug benefit. Cooke said pharmacists had reported problems billing UnitedHealthCare, which administers drug plans with the AARP brand and has the highest enrollment. She read an e-mail from a pharmacist: “It is now 1 a.m. and I am still at work since 9 a.m. transmitting claims for Part D. During the day, I could get no AARP claims to go through.”

“We had initial issues that affected our systems, but at the present time, we are seeing high service levels and 99 percent of all claims submitted are being processed within one second,” replied Peter Ashkenaz, a spokesman for UnitedHealthCare.

Last year, Cooke and her colleagues returned from the New Year's holiday to find their telephone message systems overflowing with complaints.

Under the program, beneficiaries can choose from 50-plus plans serving their states. They pay a monthly premium and for some of the costs of their medicine. The federal government picks up most of the initial expense. But once total drug costs reach $2,400, there is a gap in coverage – the so-called “doughnut hole” when the plan will pay nothing toward the cost of the drugs. That gap continues until total drug costs total $5,451. Then, the government begins paying again at a rate of 95 percent.

The poor get extra help with the cost of their medicine.

About 23 million people are enrolled in drug plans. People could switch plans or enroll for the first time from Nov. 15 through Dec. 31. Deadline exceptions will be allowed for some seniors, particularly about 250,000 people enrolled in plans that failed to properly notify them of changes in their coverage. The federal government gave them another six weeks to make a switch if they want.

Going into the new year, federal officials were most worried about those seniors who waited until the final few days to change plans. However, surveys indicated that few seniors would do so. The Kaiser Family Foundation polled seniors in early November about whether they would change drug plans. Only 5 percent said yes. About 66 percent said no. The remainder said they had yet to make that determination.

Beebe said a federal mandate that insurers provide an emergency 30-day supply of medicine has helped limit problems. She also said that some consumers learned from last year. They filled their prescriptions just before the end of 2006 so that they wouldn't have to deal with problems that they encountered last January.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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