Headache for pharmacies
Medicare: The new year brings a new program, and that means things can get confusing
Richard Chambers came into West Main Pharmacy Thursday hoping for the best.
The Medford man's first encounter with the brand-new Medicare drug program wasn't going well. A prescription that was supposed to have been sent to the Bi-Mart Pharmacy on West Main Street wasn't there when he went to pick it up. He dropped by the West Main Pharmacy on the off chance that someone might have sent it there by mistake.
We don't have anything, a clerk said when she checked under his name.
I guess I'll have to go back to the doctor and see what happened, said Chambers, 65.
Local pharmacies are the places where the glitches surface in the new program known as Medicare Part D, which began Jan. 1. The pharmacies are in the middle of every transaction ' receiving prescriptions from physicians, sending them off to insurance companies for verification and dispensing drugs to customers.
For some people, the whole process has worked remarkably smoothly, but when something goes awry, it surfaces in the pharmacy.
From our perspective, we've been pulling our hair out, said Jeff Harder, owner of West Main Pharmacy.
Harder said there have been two major obstacles to filling prescriptions: some customers haven't received identity cards from their insurance companies; and some insurance companies haven't put all their enrollees' data into their computers.
The identity cards have three sets of numbers that allow pharmacists to route the prescription to the appropriate insurance company. Without the card, or an acceptance letter with the same numbers, pharmacists can't process a prescription ' even for someone who has enrolled with an insurance company.
Having a card doesn't guarantee that everything will go smoothly. Prescriptions for some people who had ID cards were rejected by insurance company computers that had no record of the person with the card.
They're issuing cards and letters prior to getting people loaded into the insurance data base computer, Harder said.
There have been other problems, too. Harder said some insurance company computers have been producing erroneous error messages for rejecting claims. When members of his staff tried to call technical support to resolve the issue, they were left waiting on hold for an hour.
It's taking a lot of time away from our normal staffing, he said. Hopefully they'll sort it out soon.
Other pharmacies have encountered many of the same difficulties. Tim Lichlyter of Black Oak Pharmacy said some of his staff members were on hold for 45 minutes trying to get answers from insurance companies.
Few people familiar with Part D expected it to roll out trouble-free, if for no other reason than its vast complexity. Many states, including Oregon, offered seniors 40 or more plans to choose from, with a bewildering array of deductibles and covered drugs.
Lichlyter said Part D's initial problems were no more than I would have expected.
The program is open to anyone over age 65, regardless of income, but so far relatively few seniors have enrolled. The Wall Street Journal reported this week that only about — million of the roughly 17 million Americans for whom the program would make sense have signed up.
It works like this: Seniors pay a monthly insurance premium and pay out of pocket for the first &
36;250 of their medicines. Medicare picks up 75 percent of the next &
36;2,000 in drug bills. Seniors have to pay the next &
36;2,850 out of pocket before Medicare starts paying again, at 95 percent of total cost.
That means Medicare picks up about two-third of the tab for seniors who spend &
36;2,000 on drugs, but only about 30 percent of the total cost if you spend &
36;5,000. The hole in the coverage is one of the features that has drawn the most heat from critics of the plan.
What you need to know
Seniors can still enroll in the Medicare prescription drug program, and several organizations are helping people navigate the computer program that determines which plan is best.
Volunteers at the Ashland Senior Center, 488-5342, are available on Thursdays between 10 a.m. and 1:30 p.m. by appointment only.
Help is also available at the Medford Senior Center, 772-2273, during the morning hours on weekdays, but appointments are required.
The Retired Senior Volunteer Program at Rogue Valley Manor Community Services, 857-7780, provides assistance by appointment only on Wednesdays and Thursdays from 9 a.m. to — p.m.
Help is also available at Rogue Community College's computer lab in Medford's Central Library on Tuesday, Wednesday and Thursday from 9 a.m. to noon by appointment. Call 857-7780.
Headache for pharmacies"firstname.lastname@example.org.