Charles and Martha Edwards spent a lifetime building a personnel service that fizzled along with the economy in 1991.

Now in their 80s, they've been getting by on Social Security, which was OK until Medicare Part D took effect. Between them, the Greer couple takes 17 medications. And they've just reached the gap in coverage known as the "donut hole."

"We could manage the amount we would have to pay each month ($350) up to the gap," Charles Edwards said. "But when we hit the gap, our bill would be over $1,000 a month. And we couldn't do that. That's over half our income."

Reaching the donut hole -- a gap in coverage for $2,250 to $3,600 worth of drugs -- is one of the latest wrinkles in the Part D prescription drug program, which has been plagued by problems since its rollout last November. And some advocates expect other problems as the May 15 deadline to sign up for Part D approaches.

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"It would be great to extend the deadline," says Teresa Arnold, legislative director for AARP South Carolina, who adds that people are still learning about Part D.

One of the major obstacles, she said, is the number of plans to choose from -- more than 40 in South Carolina -- each with different options.

"Each person has to pick a plan that's right for them," she said. "It's a customized type thing, not a one-size-fits-all by any means."

Another problem Arnold has encountered is that some people who were on Medicaid and automatically enrolled onto Part D are being signed up by insurers for other plans they don't need and can't afford. Some of these people may not have realized they were auto-enrolled, she said, and others sign up for fear of being left without coverage.

Under Part D, those who fail to sign up by May 15 will face a premium penalty of 1 percent per month. And Beverly W. Allen, aging program coordinator for the Appalachian Council of Governments, says she'd like to see the penalties waived for the first year because people feel they're being forced into the program.

"If there was some way for this first year that they could consider waiving the penalty, that would be a great help for folks to have a chance to study the plan and see how it works out," she said. "And when open enrollment comes in November, they will have more information."

Greenville family practitioner Dr. Carolyn Fields says many of her elderly patients can't understand the concept of drug formularies -- the lists of drugs that plans will cover.

"Many never dealt with a formulary before and some don't understand what a formulary even means," she says. "It's a hassle. And confusing to a lot of these patients."

Fields agrees that extending the deadline might be a good idea.

"A lot of people signed up for plans on the basis of a salesman being nice, not understanding the plan," she said. "Then they're stuck with it for a year."

According to Medicare, 30 million Americans have enrolled in Part D -- 8 million of them are people who had no drug benefit before -- and 270 million prescriptions were filled in the program's first three months.

But while some people have better coverage under Part D, others are worse off than they were before under retirement or other coverage plans, according to the Medicare Rights Center in New York. The consumer group says many seniors are now facing gaps in coverage, high out-of-pocket costs, and routine denials of coverage for drugs.

A new report from the Kaiser Family Foundation found that plans "vary significantly in terms of covered drugs, out-of-pocket costs for specific medications and restrictions placed on the use of certain drugs." The report looked at 1,222 of the 1,429 plans available nationally.

Other aspects of the program seem to be improving.

Pharmacists, for example, who were overwhelmed when Part D began, are faring better than they did the first few months, said Tracy Russell, director of organizational affairs for the South Carolina Pharmacy Association.

"Customers are starting to hit the donut hole, and we're encountering a few problems with that, and there are some problems with transmission and coordination with insurance companies," she said. "But for the most part, it seems to be running a lot smoother than it did in the first few months."

Even pharmacists who had dispensed prescriptions on credit are finally being reimbursed, said Russell.

"A lot was going out but nothing was coming in," she said. "Some insurance companies are still slow. But things are starting to get caught up."

Allen had feared that May 15 might wind up being a mad rush more akin to April 15. But so far, she says, her office hasn't gotten the volume of calls they'd expected by this time.

And Fields says she's also seen patients who are paying less than they did before.

"The patients who have problems with formularies are very unhappy. They hadn't expected all of that and when letters come in the mail, they are at a loss for what to do," she said. "But the majority of these patients are happy."

A new Kaiser poll found that eight in 10 seniors in the plans filled at least one prescription and had no problems, while two in 10 did.

Meanwhile, America's Health Insurance Plans said last week that it has developed a standard form that doctors can use for prior authorizations and non-formulary drug requests, and that it is simplifying electronic claims processing for pharmacists as well.

And Arnold said that while plans can now make formulary changes in certain circumstances, beneficiaries are exempt from the worst of these -- removal of a drug, moving a drug to a less preferred tier status, or addition of utilization management requirements -- for the remainder of the plan year.

"Providing greater stability in plan formularies is one of the key improvements we have been seeking on Part D," she said, "and this should alleviate a major concern among both beneficiaries and advocates."

The state Department of Health and Human Services has sent more than 7,000 letters to former SilveRxCard beneficiaries who reached the donut hole to remind them of the deadline and list the companies that offer GAPS insurance.

GAPS, or Gap Assistance Pharmacy Program for Seniors, provides coverage for the donut hole to eligible residents. But only a few companies offer it. Seniors who want GAPS but who have already enrolled in a plan that doesn't offer it need to switch, HHS spokesman Jeff Stensland said.

Charles Edwards says his household income is just above what is allowed for the federal low-income gap subsidy under Part D. And he didn't apply for GAPS because it would have made him ineligible for private assistance plans offered by the drug companies.

So now the 82-year-old is applying to pharmaceutical manufacturers for help. Some have agreed to provide the drugs free, he says. But he's waiting to hear from others. If they don't come through, he says, he'll go to his own Plan B.

"I think what I'll do if we don't hear from them is order the drugs from Canada," he said. "I think we could do as well."