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State, pharmacies differ over Medicare solutions

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WASHINGTON -- South Carolina health officials are considering giving temporary relief to low-income seniors affected by errors in the new Medicare prescription drug plan, but state pharmacists groups said Monday that stepping in at this point would add more confusion.

More than two dozen states, declaring public health emergencies, have put up money to help pay drug costs for Medicare recipients in their states who are having trouble with the program, which began Jan 1.

The new drug coverage is administered through private companies, and many seniors have complained of errors such as having to pay high co-payments or not having their plans honored.

Even before the plan to provide Medicare coverage for seniors' prescription drugs went into effect, the South Carolina Department of Health and Human Services planned to allow "dual-eligible" low-income seniors the chance to revert back to coverage provided under the state's Medicaid program.

A small number of seniors have been helped by that plan. The Medicaid drug coverage for low-income elderly people was phased out when the Medicare drug plan began.

Late last week, however, state officials began exploring whether to take further steps to help low-income seniors who were faced with errors such as having to pay exorbitant co-payments or their plans not being honored by stores. The Centers for Medicare and Medicaid Services in Washington has said it will work with the different drug plans to pay back the states that stepped in.

But the state's pharmacists' organization Monday was lukewarm to South Carolina's possible action.

"To step in now would create another billing problem that would just exacerbate the situation," said Jim Bracewell, executive vice president of the South Carolina Pharmacy Association. "We would tend to think now that certainly the problem is not cleared up, but the acute crisis is cleared up."

During the first few weeks of the plan, Bracewell said, pharmacists were waiting on the telephone for hours trying to reconcile claims with seniors and drug plans. Now many pharmacists have got a better handle on the situation, he said.

Many pharmacists have had an increased burden of responsibility and are giving out prescriptions with no certainty of a payment from drug providers. But despite all the confusion, Bracewell said, the state intervening would add another layer of complexity.

He said he was not aware of any low-income seniors not being able to get prescriptions.

"The headache now is to work out all that billing and collect that money," Bracewell said. "But to start billing to the state would be more confusing."

State Health and Human Services Department spokesman Jeff Stensland said his agency has heard similar opinions from other pharmacists. The state has not made a final decision on whether to intervene, but will give weight to the pharmacists' recommendations, he said.

Chris Kirkham writes for the Medill News Service in Washington.