City to aid Medicare launch

Health agency to monitor seniors' needs as drug plans shift

December 21, 2005|By M. WILLIAM SALGANIK | M. WILLIAM SALGANIK,SUN REPORTER

Baltimore City Health Department will announce today that it will set up a 24-hour system to ensure that thousands of low-income elderly and disabled will get needed medicines as they are switched from state-run programs to the new Medicare drug plan Jan. 1.

The new system will monitor problems and help resolve them quickly, Dr. Joshua Sharfstein, the city's health commissioner, said yesterday.

In urgent cases, the city will pay for prescriptions to be filled to ensure an uninterrupted supply, but more often he expects the city will help people to enroll for the benefit or pharmacists to resolve billing problems.

The city's announcement comes as government officials, advocates and trade groups say they are worried about glitches in supplying medicine to the frail as millions of people have their coverage changed.

A Government Accountability Office report issued last week said there may be problems in getting people enrolled to maintain their medications, but "the likelihood and magnitude of these potential problems is not known."

Jeff Gruel, director of the pharmacy program for the state health department, said yesterday that an undetermined number of people in Maryland state programs haven't yet been confirmed as signed up for a Medicare plan, but the state expects more enrollment information later this week.

The federal Centers for Medicare and Medicaid Services (CMS) says it has contingency plans in place to make sure people get the medicines they need.

The shift occurs as part of the general launch of Medicare prescription benefits, in which more than 40 million elderly can choose pharmacy plans. Most of those who enroll will be getting a pharmacy benefit for the first time, so they don't face the problem of changing to different insurance coverage.

About 6 million nationally, however, are currently in state-run programs for people with low incomes. They will be automatically switched into one of the private Medicare plans.

The concern is that some will get lost in the switch-over, and others may find their new benefit doesn't cover the same medications or use the same pharmacies that they're used to - leading to an unpleasant surprise when they try to have prescriptions filled in January.

In the city, 28,000 people who now have their prescriptions covered by Medicaid or other state programs will be shifted to Medicare; in the state, about 80,000 will be.

"If one person switches, it's an insurance issue," said Sharfstein. "When 28,000 people switch on one day, it's a public health issue."

The city will have a 24-hour phone line for pharmacists, and has developed a database to track problems. The city's Committee on Aging and Retirement Education aims to contact Medicare beneficiaries who need help enrolling within three days, and to resolve problems within seven.

Tricia Neuman, vice president of the Kaiser Family Foundation, said she wasn't aware of any other local or state government with a monitoring program like Baltimore's, which she termed "very exciting." Although CMS has protections in place, she said, "like any new, big system, there are bound to be glitches, and a glitch in this might mean that elderly and disabled people can't get their prescriptions filled."

Clare Whitbeck, legislative chair for both United Seniors of Maryland and Voice for Quality Care, a group of families of nursing home residents, said she was worried about people who may fall through the cracks.

"There are going to be a few people who just didn't make it from one system to another," she said.

However, she added, "We don't know who these people are because they don't know who they are."

Peter Ashkenaz, a CMS spokesman, said the federal agency welcomes a program like Baltimore's, which he said could provide useful feedback to CMS and to the insurers running prescription plans. However, he said the agency is confident its contingency plans will protect seniors who need medications.

For those who are not enrolled - for example, if a state didn't send CMS a complete list - Ashkenaz said that people can be "enrolled while standing at the pharmacy" in a temporary national plan.

For those who are enrolled but find that their medications aren't covered, Ashkenaz said, CMS is urging the prescription plans to pay for a 30-day supply. That would give the patients enough time to appeal to the plan to cover the medication in the future, to talk to their doctor about changing to a similar medication which is covered, or to switch to a plan that pays for the medications they want.

Both Ashkenaz and Sharfstein compared the preparations - with staff on standby at the stroke of midnight on New Year's Eve - to the anticipated, but unrealized, computer problems feared at the change of the millennium. "People are hopeful this is going to be a smooth transition, but it's our job to prepare," said Sharfstein. "I hope this is like Y2K."

bill.salganik@baltsun.com

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