States wading in to fix Medicare mess

WASHINGTON — Low-income Medicare beneficiaries around the country were often overcharged, and some were turned away from pharmacies without getting their medications in the first week of Medicare's new drug benefit.

The problems have prompted emergency action by some states to protect their residents.

Although there are no definitive numbers, concerns expressed by state officials and complaints from pharmacists suggest a widespread pattern of problems.

At least four states — Maine, New Hampshire, North Dakota and Vermont — acted this past week to make sure poor people receive the drugs they were promised but could not obtain through the federal Medicare program.

Gov. Jim Douglas of Vermont, a Republican, said the state would pay drug claims for low-income people until the federal government fixed problems in the new program, known as Part D of Medicare. Michael K. Smith, the state's secretary of human services, said, "The federal system simply is not working."

Many factors have contributed to the situation. Some people who enrolled in Medicare drug plans did not have any proof of coverage. Pharmacists could not receive the information needed to verify eligibility for drug benefits and low-income subsidies. Insurance companies and their pharmacy benefit managers were swamped with calls, so pharmacists often had to wait an hour or more on telephone "help lines."

Federal officials promised improvements, but state officials were growing impatient.

In New Hampshire, Gov. John Lynch, a Democrat, signed an executive order authorizing the state to pay drug claims that he said should have been covered by Medicare. The start of the Medicare drug program "has been a nightmare for many of our citizens," Lynch said.

"Many are being charged unaffordable co-payments for prescription drugs — co-pays much higher than they are supposed to be. Too many of them are leaving pharmacies without their prescriptions," he said.

Roseanne Pawelec, a spokeswoman for the federal Medicare agency, said Saturday that federal officials were working closely with states to address their concerns and to help individual beneficiaries.

"Things are improving on a daily basis," Pawelec said. "As computer systems catch up with late December enrollment, the problems are rapidly disappearing."

But in an interview on Friday, Stan Rosenstein, the Medicaid director in California, said: "We are hearing more and more complaints. A significant number of people are not getting their prescriptions. That has us very troubled."