Posted on 01/21/2006 10:12:47 AM PST by NormsRevenge
NATIONAL CITY – Even if it works as it should, Medicare's Part D drug program for low-income seniors and disabled patients is so flawed that it must be scrapped, patients, doctors and lawmakers said during an emotional rally yesterday.
"You guys got to admit you made a mistake and repeal this damn thing," Rep. Bob Filner told Medicare regional administrator Jeff Flick, who had come from San Francisco to the Kimball Senior Center to defend the federal government's plan.
"I want you to sit in my office and hear (patients') calls. What are you going to do when people start dying?" Filner asked Flick as dozens of patients, physicians and TV cameras stood nearby.
Filner, D-San Diego, said legislators "should go back to Washington and if not absolutely repeal the program, delay it until next year."
Flick replied that Medicare officials are rapidly fixing "some glitches and some problems" that since Jan. 1 have prevented many of the nation's 7.2 million "dual eligibles" from filling prescriptions.
These are patients who qualify for Medicare and Medicaid, called Medi-Cal in California.
Flick promised to have his staff investigate each complaint and urged beneficiaries with questions to call (800) MEDICARE.
The problems started 21 days ago, when these dual eligibles – about 1 million in California and 66,000 in San Diego County – began receiving prescription drug coverage from designated commercial plans.
Since then, an estimated 20 percent of those who tried to fill a prescription have encountered problems, mainly that their names didn't appear on eligibility lists.
Many of these low-income patients were asked to pay hundreds of dollars in premiums or deductibles that a special federal subsidy was supposed to eliminate.
Many said they walked out of the pharmacy without their drugs.
Some patients who were listed on the pharmacy's computers were told their plan didn't cover the drugs they were taking. Even if the plans did cover their drugs, many beneficiaries were asked to pay co-payments of $1 to $5 per prescription.
Their co-payments, multiplied by the number of drugs most of these patients need, have eaten up their budgets for food and housing, health advocates said.
The problems are pervasive nationwide: Nearly 30 states have set up 30-to 45-day emergency transition plans to make sure patients do not fall through the cracks.
Many who gathered at yesterday's rally said that even if the problems are fixed, the new drug program is riddled with complications.
"Part D stands for 'disaster.' The only better name would have been Plan F – F for fiasco," Filner said.
At his side was Rep. Susan Davis, D-San Diego, who called Plan D "the (Hurricane) Katrina of health care because, like Katrina, the man-made disaster that followed has been catastrophic."
Davis described one patient who was assigned to a plan that was supposed to cover a life-saving drug he could get for a $1 co-pay. Instead, "He was forced to pay $74 he didn't have. And when he called the plan, he was on hold for five hours and never got through."
South Bay doctors Ben Medina, Sandra Perez, Maria Puig and John Videen asked their patients to attend the rally to explain their experiences and fears.
One of them, Arthur Romero, said he was asked to pay a $3 to $5 co-pay for each of 25 drugs he used to get for free until Jan. 1 for his failing eyesight and kidneys. As a result, he had to overdraw his bank account multiple times, incurring a $25 bank charge each time.
Maria Vasquez found she couldn't get her drugs through her new plan, said her granddaughter, Judith Rosales Castillo. "I've been trying to call the plans," Castillo said, "but each time they say they're sorry for the high volume of calls and then they cut you off. We're in the dark."
Dearled Knotts was disabled in a car accident and now needs 26 medications for pain and diabetes. He doesn't know what drug plan he's in. "I was told I fall in a gray area. I've been on the phone 80 hours on hold since Dec. 28," Knotts said.
Even when patients know which plan they're in, determining each plan's drug costs can be extremely difficult, said Greg Knoll of the San Diego Consumer Center for Health Education and Advocacy.
As an example, Knoll pointed to James Sharples of Normal Heights. Sharples became disabled 12 years ago after an 800-pound air compressor fell on his back during work.
These days, Sharples must fill 13 prescriptions. He hopes that his new plan, PacifiCare Prescription Solutions, will cover them all – just as Medi-Cal did last year. Of the three prescriptions Sharples has tried to fill, he was asked to pay $53 for a 30-day supply of one and $200 for another.
A PacifiCare representative guided a reporter through the plan's Web site, which allows people to type drug names and doses to learn how much a patient must pay for each medication.
The site calculated Sharples' co-payments at $681.68 a month. He receives $724 in disability benefits per month.
Two of Sharples' 13 drugs are the most expensive because they're brand names not listed on PacifiCare's formulary. These medications, Soma and Oxycontin, make up $633.08 of the monthly cost.
Substituting those two drugs with generics would drop Sharples' monthly bill to $64.25. But the generics make him vomit, he said, and the total price is still more than he can afford.
A patient with these prescriptions shouldn't have to pay that much money if his physician submits a "prior authorization" request, said PacifiCare spokeswoman Cheryl Randolph. If the request is approved, the co-pay for a nonformulary drug would be $3, she said.
If Sharples was told he had to spend more, Randolph said, it was a mistake.
Randolph did her own calculation of the 13 drugs and came up with a monthly figure of $21. A patient can have additional savings by ordering 90-day supplies through the mail, Randolph added.
Rally organizer Ted Mazer, a physician and president of the San Diego County Medical Society, said federal officials should realize the burden on busy doctors who serve poor, elderly and disabled patients.
Physicians and pharmacists have had to "face incredible increased work . . . just to maintain treatment for their patients," Mazer said, such as helping them select plans, file paperwork and address problems, and that's unreimbursed time.
This expanded workload, along with a 5 percent Medi-Cal pay cut imposed on physicians starting Jan. 1, means a growing number of doctors will refuse to take dual eligibles, Mazer said.
At the national level, many patient advocates have said the federal government should do away with Medicare Part D for dual eligibles.
Jeanne Finberg, attorney for the National Senior Citizens Law Center in Oakland, which represents patient advocacy groups nationwide, shares that perspective.
When physicians and pharmacists have trouble understanding the complex mix of drug plans, formulary exclusions and grievance procedures, she asked, how can the government expect low-income people who are old, sick or disabled to navigate the system?
"It's just too complicated," Finberg said in a telephone interview. "This has just been a callous response to the plight of America's most vulnerable."
--and again , the Republidum group, comprised of most of Congress and the administration, shot themselves in the foot---
Yikes! I agree with a Democrat.
Thank you, big government Republicans, for this boondoggle.
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