Prescription card plans cause users headaches Computer errors, changes abound

January 16, 1992|By Michael K. Burns

Changes in prescription drug card plans for hundreds of thousands of Marylanders caused headaches for many of them this month.

Computers rejected many cards as ineligible for benefits, parents found they could not get prescriptions for children who were not in the computer bank, and elderly people on maintenance drugs were shocked when told they had to pay the full amount because their cards were invalid.

Some employees found that their neighborhood pharmacy was not participating in their new prescription plan network. And some people apparently did not get the new prescription cards or mislaid them in the holiday rush.

"People were very upset; some even cried when they were told by pharmacists," said Lance Berkowitz, the owner of Arcade Pharmacy in Hamilton and president of the Baltimore Metropolitan Pharmaceutical Association. He hired two extra employees just to handle phone calls to employers and card processors to work out problems.

The situation forced pharmacists to make instant medical decisions.

"In many emergency cases, with seniors or a sick child needing expensive antibiotics, we were literally lending them the prescription on the hope that we would be reimbursed at a later date, even though their cards could not be confirmed," Mr. Berkowitz said.

"This was a debacle," added David Miller, executive director of the Maryland Pharmacists Association.

But most of the glitches have been corrected, computer data bases revised and employees contacted to provide required lists of dependents, he said yesterday.

Although drug benefit plans are changing more often as employers try to restrain rising costs, this New Year's changeover was particularly heavy: Nearly 105,000 state employees and retirees, 7,500 Blue Cross Medicare supplemental policy subscribers, about 12,500 Westinghouse Electric Corp. workers and some 6,000 Maryland National Bank employees changed plans. Plus their dependents.

The impact was compounded by new demands that pharmacies confirm dependent eligibility and by a devastating flu epidemic that struck early in the season, in addition to the inevitable errors involved in massive computer data transfers to new prescription processing companies.

The widespread use of card validation computers in drug stores also resulted in immediate rejection or approval of prescriptions, rather than catching errors days after the prescription had been filled, Mr. Miller noted.

Baltimore City employees had just changed their prescription processors in December. Problems arose because the new plan required drug stores to verify eligibility of municipal employee dependents from a computer base that had errors, Mr. Berkowitz noted.

The massive changeover in the state employee prescription plan from Blue Cross of Maryland to Prescription Card Services Inc. in Arizona, and the necessary transfer of massive data to the new company's computer system, produced some glitches, Mr. Miller said.

But state employees themselves added to the problem.

Some tried to use the old cards. And some 25,000 dependents were not covered, because employees didn't send in required updates on their dependents' status, despite repeated mailings from the Department of Personnel, state officials said.

Personnel Secretary Hilda E. Ford herself fell victim to the change. Ill with the flu this month, she tried to fill a prescription at the pharmacy with her old Blue Cross card.

"I know I got the new card, but I don't remember where I put it," she said. "So I had to pay up front for the prescription. I guess I'm no different from a lot of other people in the system."

Dozens of elderly people relying on the Maryland Blue Cross Premium Medicare supplement policy also were caught up by computer errors that produced false birth dates, Mr. Berkowitz said.

"On Monday, our store had 27 consecutive patients with [prescription] cards that had errors in the computer system," he said.

But Christina Saarlas, a spokeswoman for Maryland Blue Cross, said the insurer and its prescription plan processor had received an insignificant number of calls about that problem.

"It's the first we've heard of any real problems" on the changeover, she said.

Both the city and state have worked with the pharmacists' group to iron out the problems, Mr. Miller said, and no pharmacy has yet been denied reimbursement for prescriptions issued in good faith.

A different problem arose when MNC Financial Corp., parent of Maryland National Bank, switched Jan. 1 to a new prescription processor (PHS of California).

MNC's bulletin to employees indicated that only major drug chains could be used. Neighborhood pharmacists then complained to MNC, which said there was a misunderstanding, explained Don S. Hillier, human resources vice president.

A new letter is going to employees and retirees explaining that nearly all Maryland pharmacies are included in the new PHS network, he added.

Westinghouse restricted its prescription plan to a few large chains, eliminating all independent pharmacies, Mr. Berkowitz said. A few drug stores around the company's main Linthicum complex, whose business relies on filling Westinghouse employee prescriptions, were added to the system after they threatened legal action, he added.

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