Saturday, January 14, 2006

Crash & Burn: the Medicare drug benefit in implementation

The Medicare mess, as reported in the WaPo.

Two weeks into the new Medicare prescription drug program, many of the nation's sickest and poorest elderly and disabled people are being turned away or overcharged at pharmacies, prompting more than a dozen states to declare health emergencies and pay for their life-saving medicines.

Computer glitches, overloaded telephone lines and poorly trained pharmacists are being blamed for mix-ups that have resulted in the worst of unintended consequences: As many as 6.4 million low-income seniors, who until Dec. 31 received their medications free, suddenly find themselves navigating an insurance maze of large deductibles, co-payments and outright denial of coverage. …

... The states that have stepped in to help have already incurred several million dollars in unexpected drug bills, but Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services (CMS), said he did not have the authority to reimburse them. He urged states, pharmacists and providers to work with his agency to collect reimbursements from insurance companies administering the prescription program.

Acknowledging that some of the 6.4 million low-income beneficiaries known as "dual-eligibles" have been overcharged or denied medication, McClellan said: "That is simply not acceptable. We have been working around the clock and around the country to make sure those beneficiaries get the prescriptions they need." …

… The first state to act was Maine, after its hotline recorded 18,000 calls on Jan. 3, said Jude Walsh, a special assistant to the governor.

"We had dialysis patients who were not getting medicines, pharmacies on hold for 60-plus minutes, some plans closed for the holiday," she said, describing some of the frantic calls. "One man called me -- he and his wife were on 15 medications. They had no co-payments on Medicaid. He went in for 15, and he left with one" medicine because of the cost, she said.

If we all thought that incompetence ruled the day in the aftermath of Katrina, just wait until this mess goes under resolved for weeks, months. This is a potential nightmare for incumbent politicians, particularly if professionals involved in health care are overwhelmed to the point that they’ll register protest votes in November.

Incompetence in the form of failed implementation is not something voters tolerate.


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