10 Days To Start Of New Medicare Drug Program—Problems Reported

It should be obvious to everyone that getting the new Medicare prescription drug program off the ground is a monumental task getting about 41 million prospective enrollees into about 100 programs no two of them nearly alike.

The enormity of the task becomes more difficult when the emotional impact on everyone involved, the sensitive medical and financial questions, and the need on the part of the federal government to make the administration of this multi-billion-dollar program as free from fraudulent influences as possible are all factored in.

It should come as no surprise then that since enrollment began on November 15, problems have surfaced that will produce massive headaches for the federal Centers for Medicare and Medicaid Services (CMMS), which is administering the massive program; the insurance industry, which is providing the drug insurance; the pharmacists, who will do the actual job of dispensing prescriptions, and finally, the nation’s seniors, the most important piece of the pie because their continued good health and lives are on the line.

Reports out of Washington last week revealed that insurers were experiencing delays in getting approval of enrollments they had submitted to the CMMS.

This was preventing the whole process moving forward because without CMMS finalizing work on an enrollment application, a health insurance company cannot issue an identification card to an enrollee.

You’ll be hearing a lot about identification cards and their importance to seniors in getting the drugs they order from pharmacists. According to reports, pharmacists warned that without an Identification Card, a senior would have difficulty in getting prescription drug orders filled by a local pharmacist.

Responding to the insurers’ versions of the problems, a CMMS spokesman said that his agency had found errors in data submitted by healthcare insurers so the applications had to be returned to be corrected. This caused delays in getting final approvals.

The CMMS role is to conduct a verification process to confirm that applicants are eligible to enroll, but insurers say this is being done too slowly and the process is being delayed.

Meanwhile, the CMMS spokesman, responding to pharmacists’ warnings about the lack of an Identification Card, said pharmacists should contact CMMS via computer to verify the enrollment of a program beneficiary.

In addition to the many difficulties reported by seniors about the incomprehensibility of the programs being offered by insurance companies and the difficulty in choosing one that best meets their medical and financial needs, add the woes being experienced by insurers and CMMS in getting this massive program out of the starting gate by January 1, which is only 10 days away.

Make no mistake about this: it is a very serious problem.

Seniors not enrolled in an insurance plan under Medicare will not receive the savings the program was created to deliver. Worse still, this could cause interruptions in securing daily medication seniors may need to continue to stay well and functioning. Needless to say, there could be even more serious consequences.

This is a situation where a senior cannot choose to sit back and hope that somehow the problem will resolve itself. Remember, the program is voluntary and each senior must choose an insurer and must follow up to make sure his or her application is being processed. If the insurer reports back that the final approval of an application is being delayed by CMMS, then it’s time to call your congressional representative and have him or her reach out to federal authorities to get action.

Here are some telephone numbers to call or Web sites to visit:

Medicare 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.

HICAP (state Health Insurance Information, Counseling and Assistance, 212-333-5511.

Medicare Rights Center 1-800-333-4114 ext. 1 or www.medicarerights.org.

Center for Medicare and Medicaid Services-Go to www.cms.hhs.gov and click on the line under “Spotlight”: “New Drug Coverage Includes Options for Additional Benefits and Saving Money.”

The Center for Medicare Advocacy, www.medicareadvocacy.org.

Social Security Administration 800-772-1213 (TTY-800-325-0778) or online www.socialsecurity.gov—tells whether you qualify for extra help.