December 24, 2005.
Inside Bay Area, California.
MEDICARE'S new prescription drug plan, Medicare Part D, has a lot of kinks to work out to makeaccess to it user-friendly. Enrollment began Nov. 15 and closes May 15. Those who delay will pay more for their meds the longer they wait. While the government may have put untold hours and money into designing this new structure, health care specialists complain about how complicated it is for patients to determine which plans cover their particular medications.
"I'm still waiting to see how it works out. People are calling. It's horrible, horrible," said California Health Advocates President C.A. Smith.
First, Medicare is relying on its toll-free number (1-800-MEDICARE) and its Web site (www.medicare.gov) to inform seniors about Medicare Part D plans.
But the online information is only available in English and the toll-free line only has a translation in Spanish. A high-speed Internet hookup also isadvisable.
A significant number of dual eligibles do not use English nor Spanish as their primary languages.
Because of her vision problems, Maggie Dowling finds it impossible to navigate the http://www.medicare.gov site, even after adjusting the text size from her toolbar. Like most people, she doesn't own a screen reader, a device that magnifies text many times for the visually impaired and reads the words aloud.
Finding an experienced health professional to guide the consumer also is a challenge.
Bonnie Burns, training and policy specialist for California Health Advocates, said the number of calls coming into her agency for help in navigating the Web site and deciphering the formularies was torrential.
"Dual eligibles," the elderly and disabled who receive both Medicare and Medi-Cal, not only have to know their plan, they have to know which pharmacy accepts the plan. And according to Smith, not all pharmacists accept all plans and not all pharmacists are yet well educated about Medicare Part D.
Smith said HCA field offices have learned that certain pharmacies are refusing to work with certain prescription drug plans offered under Medicare Part D.
"So where does that leave the patient? They would have to find a local pharmacy that contracts with their plan and also check out the formulary. What about more rural areas where the pharmacy choices are slim?" Smith asked.
Ann Marie Benzinger is president of the nonprofit Alpha-1 Advocacy Alliance, which educates patients with liver disease. She is appalled at the lack of consistent and plentiful public education about this complex program.
"State health departments should have been holding seminars on this every week," Benzinger said. "People are being told to go to the nearest library where the librarians are not literate in Part D. Or to go to the nearest senior citizen center where people have no computers."
The California Department of Health Services this week sent letters to all of the state's 1 million dual eligibles reminding them of the switch in their drug coverage over to Medicare Part D.
To prevent lapses in drug coverage, Medi-Cal is allowing pharmacists to refill prescriptions for dual eligibles up to 100 days until Jan. 1. So dual eligibles should get several extra months of free drugs if they go to their pharmacy before the end of December.
In addition, Medi-Cal will continue to cover some classes of drugs not covered under Medicare Part D, including Tylenol, aspirin, prescription vitamins and minerals, and barbituates.
Source URL: http://www.insidebayarea.com/businessnews/ci_3340497.
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