In the News

As published in the Danbury News-Times, May 11, 2006.

Pharmacies, Agencies Brace for Medicare Part D Deadline

By Robert Miller

When the first wave of senior citizens signed up for Medicare's new prescription drug coverage program in January, the system buckled under the confusion and pressure of starting a vast, difficult federal program.

The program's next deadline is midnight Monday — the last day seniors on Medicare can sign up for the program called Part D without paying a penalty. As a result, hundreds of thousands of procrastinating seniors may be among the last to join.

"Our phones have been ringing steadily,'' Dawn Macary,an information and assistance staff worker at the Western District Area Agency on Aging said Wednesday. "We've been very busy.''

"We're helping everyone who comes in,'' said Kathleen Oles, Bethel Senior Center director. "But they have to come in.''

January's gargantuan mess may not occur again — largely because the people running the system were forced to fix it.

"For the most part, the problems seem to have straightened out,'' said Dan Boulanger, owner of English Drug in Bethel.

"What happened was a set of circumstances that cannot be replicated,'' said Roseanne Pawelek, spokeswoman for the Boston regional office of the Center for Medicare and Medicaid Services. "With all the people signing up in January, we had systemic issues that were very stressed.''

Some, however, are trying to get ahead of any problems that may arise next week.

"We're sending out information to all our members, urging their customers to enroll by May 15,'' said Margherita Guiliano, executive director of the Connecticut Pharmacists Association. "Hopefully, things will work out better. We'll know by May 16 or 17.''

"We're anticipating problems,'' said Deane Beebe, spokeswoman for the Medicare Rights Center in New York City. "We're getting calls every day now from people with problems.''

Medicare Part D is the first major expansion of the Medicare system since its inception in 1965. Initially, it will cost at least $400 billion and cover many of the 42 million seniors enrolled in Medicare.

The goal, which Pawelek said will be reached by Monday, is for 90 percent of all Medicare recipients, or about 37.8 million people, to be enrolled in one form of drug coverage program or another.

"We've now reached 37 million people,'' she said.

Pawelek said low-income seniors can enroll after Monday without incurring penalties, which are small at first — about $30 for the first year — but increase each month a senior does not sign up.

The program requires seniors to pay the first $250 of their drug costs.

For the next $2,000, consumers will pay 25 percent, $500, while insurance pays 75 percent, or $1,500.

Then there is the controversial "hole in the doughnut.'' Consumers must pay the next $2,850 of their prescription costs. After they've spent a total of $3,600, insurance kicks in again, paying 95 percent of drug costs.

Another controversial aspect of the program is the decision to not let Medicare create a national drug insurance program and use its massive purchasing power to bargain for lower drug costs. Instead, private insurers are providing coverage.

Seniors have had to sort through dozens of available plans to see which suits them best. But many who have signed up are finding the new system will save them money.

"I had one man come in who was spending $1,800 a year on drugs,'' said Oles of Bethel. "Now he'll pay $700. He'll be saving $1,100.''

"I think a lot of people who have signed up will save money,'' said Jack Hoadley, research professor at the George Washington University Health Policy Institute in Washington. "Especially if they were paying for everything.''

"Some people say this is not a good program, but it's a beginning,'' said Macary of the Western District Area Agency on Aging. "Now we have to build on it.''

In Connecticut, about 48,000 low-income seniors receive prescription subsidies through the ConnPACE program. Michael Starkowski, deputy commissioner of the state Department of Social Services, said ConnPACE — thanks to help from pharmacists and students at the University of Connecticut School of Medicine in Farmington — have made sure all its members are enrolled in Part Ds.

ConnPACE also will pay for deductibles and added premiums. More importantly, it will provide seniors with coverage during the doughnut-hole gap, so they will not have to pay full costs.

"It should be a very cost-effective program,'' he said.

But Plan D is not without pitfalls. Judith Stein,founder and director of the Center for Medicare Advocacy in Willimantic, said some clients who signed up for Part D in January are already hitting the doughnut hole.

That leaves them in the position of suddenly making decisions on what prescriptions they can afford.

"Unfortunately, they'll be in the same position as they were before they signed up,'' Stein said.

"Some people are going to fall into the doughnut hole and never get out unless they have $3,600 to spend on drugs,'' said Beebe of the Medicare Rights Center.

Beebe also said some seniors are finding their plan doesn't cover some expensive prescriptions, but offers less-expensive alternatives — not necessarily the drug their doctors prescribed for them.

Hoadley of George Washington University said the next strain on the system will come after Nov. 15. Then, the private plans can change the terms of their coverage. Seniors may have to decide whether to switch to a new plan or stick with what they have.

"People have a tendency to not switch,'' Hoadley said. "But some seniors may have to go through the whole process again to find a new plan.''

"It will take a year's experience to see all the consequences,'' said Stein of the Center for Medicare Advocacy. "I expect there will be problems.''