New State Prescription Drug Plan Stumbles Through Initial Week

By Nancy K. Crevier

The first week of January was a time of chaos and confusion for some Medicaid and ConnPACE beneficiaries in Connecticut, as the new Medicare Part D Prescription Drug Plan fell headlong into an abyss of miscommunication and computer problems.

January is what Newtown Drug Center pharmacist Rich Gubbiotti describes as “The Perfect Storm” month, anyway, when new insurance plan sign-ups, flu season, and winter weather come together to create havoc. Adding an influx of new Medicare Part D beneficiaries to the mix, and unforeseen computer system issues at Medicare and the state, only broadened any problems they normally see this time of year.

The Medicare Prescription Drug Plan Part D is designed to provide partial payment for prescription drugs for state residents who have not been covered by a prescription drug plan. Prior to January 1, Medicare covered only prescription medicines received in a hospital or in a doctor’s office, and in a very limited number of other instances.

Medicare Prescription Drug Plan Part D requires a monthly premium, paid to a private plan, of approximately $32 per month. That is followed by an initial deductible of $250, and a second, larger deductible. Yearly prescription costs between $250 to $2,250 cost participants in Part D another $500, with Medicare picking up the remaining $1,750.

Prescription costs between $2,250 and $5,100 require another $2,850 out-of-pocket payment. When yearly prescription costs exceed $5,100, Medicare will pick up 95 cents of each dollar. For seniors who have paid out of pocket for large quantities of expensive drugs every year, the plan is to their advantage, despite the premium costs and deductibles.

Clients of ConnPACE, a state program that provides coverage for part of prescription costs, are covered by the new plan, as ConnPACE wrapped around the new Medicare drug plan. Recipients of the plan were initially told to enroll in any plan by January 1. Then in December, ConnPACE opted to auto-enroll members in plans best suited to each member, based on their drug use. ConnPACE is supposed to pay the premium and deductibles.

What ConnPACE and Medicaid members found last week, however, was that pharmacies were unable to verify enrollment in any plans. Across the state, pharmacies in some situations refused to fill prescriptions, overcharged for co-payments, or required full payment for the drugs dispensed. Those unable to pay in full were turned away.

Customers of Drug Center Pharmacy in Newtown did not have to worry about their eligibility status when refilling prescriptions.

“We never let people walk out [of the Drug Center] without anything,” Mr Gubbiotti said. “We always give them some supply to get them through.”

The pharmacy did not encounter any difficulties filling prescriptions for customers, he said, even though “eligibility checks did not always work so well all of the time last week.”

Where Mr Gubbiotti has seen a stir of activity for the past several weeks has been in people seeking help with selecting a plan. For many of those eligible, it means weeding through 44 private insurance plans to find the one that best suits their needs. Mr Gubbiotti attended seminars presented by the Connecticut Pharmacy Association and other pharmacy organizations to prepare for consultations to Drug Center customers.

“We can’t recommend a plan,” he explained, “but we can show plan choices that might suit [the customer].”

A trained pharmacist can work through each case individually and help clients determine if the Part D plan selected includes drugs pertinent to that individual. This is particularly important for people who are being auto-enrolled by ConnPACE, he stressed. “We’ve been spending time with people,” he said.

In other parts of the state, the transition to the new drug plan did not go so smoothly.

“We had a lot of problems last week,” admitted Dawn Macary of Western Connecticut Area Agency on Aging, “but we hope they are cleared up by the end of Tuesday [January 10].” She noted that the eight phone lines at WCAAA, which had remained constantly lit up with incoming calls for two days straight last week, had calmed down considerably by the early part of this week.

To her knowledge, the problems stemmed from improperly working state computers, as well as some confusion on the part of the beneficiaries.

“Many Medicaid recipients had received notification letters informing them of which plan they had been signed up for, but they may have tossed them out, not knowing what they were. They get so much paper,” said Ms Macary. Computer problems added to the difficulties when ConnPACE and Medicaid members tried to get prescriptions filled and pharmacies could not identify the private plans selected.

Gov M. Jodi Rell, in an effort to ensure proper prescription dispensation to the 65,000 Medicaid and ConnPACE beneficiaries, directed the state Department of Social Services late last week to reimburse pharmacies when problems arise. Once the situation is resolved, the state will recoup from the private insurance plans money paid out to pharmacies.

A notice was sent out to the Pharmacy Association and Chain Drug Store Association by the Department of Social Services for distribution, detailing steps to be taken when problems are encountered.

Any clients in Newtown who have encountered problems so far with the new prescription plan have not approached Newtown Social Services director Joanne Klopfenstein. She cautioned, however, that enrollment problems may not appear until later this month. Anticipating problems with the new system, “social service agencies recommended participants to fill their drug prescriptions at the end of December if they had an old plan” she said. “We may see problems the end of January when [participants] try to fill their prescriptions for February.”