Many problems have hampered implementation of the Medicare drug law, which took effect in January.
More than a dozen states declared health emergencies and offered to pay for lifesaving medicines when they discovered many of their sickest and poorest elderly and disabled were being turned away or overcharged at pharmacies.
The new drug law also hit nursing homes hard as questions about plans’ coverage and residents’ eligibility continued to mount.
Computer glitches, overloaded telephone lines and poor implementation were being blamed for many of the early mix-ups. At press time, Ohio and Wisconsin announced they would cover drug costs for low-income seniors who would otherwise go without, joining every state in New England, as well as eight others.
Hailed as President Bush’s signature domestic achievement, the program offers drug coverage for the first time to 43 million seniors and disabled Americans eligible for Medicare. Many implementation challenges are expected to be worked out in the next few months. But that is a small consolation to providers who are finding it easier to find problems than answers.
LTC operators struggle
As a new drug law took effect, many operators struggled to cope with the biggest change to the Medicare program since its inception.
Many facilities are still attempting to understand and implement 43 different drug plans. Each plan is subsidized by the government but administered by private companies.
More than two-thirds of the 1.7 million Americans in nursing homes receive Medicaid coverage. Many were randomly assigned to federally financed prescription drug plans that did not necessarily cover the drugs they were taking.
Providers face several major obstacles. These include making sure that residents are actually signed up for a plan. Facilities also must assess the random assignments of residents. Further, they must decide whether to appeal drugs not covered, prescribe different ones or switch plans.
Each plan also has tiered subplans. And each of those has its own formulary, the list of drugs that are covered, and its own appeals process for those that are not. Yet many of the plans have still not posted appeals applications on their Web sites.
States that have stepped in to help already have incurred several million dollars in unexpected drug bills. California Gov. Arnold Schwarzenegger said he expects reimbursement.
But Medicare chief Mark McClellan said he isn’t authorized to require such payments.
