Some give Part D an ‘F’

When Dee Daly stepped up to Barry Feely’s Medicine Man pharmacy counter in Hayden this week, neither knew quite how the transaction would conclude.

Daly, 49, needed to renew the first of 22 prescription drugs she takes for a range of ailments, most sparked by a severe head injury a decade ago.

Feely, 55, needed to route her request through the government’s new Medicare Part D drug benefit, which dramatically altered the way prescriptions are paid for starting Jan. 1.

Both were leery of the complicated federal program, which is expected to subsidize benefits for some 30 million seniors and disabled people at a cost of $724 billion over the next 10 years.

And both say their skepticism was warranted, even as local and regional social service workers report that North Idaho is avoiding the most serious problems that have plagued the rollout in other states.

“It’s a joke,” said Daly, a Rathdrum resident who keeps her drugs in a locked box. “It’s been terrible.”

“It’s got us pretty well snowed,” said Feely. “The system didn’t work. The first day it went down. I’ve almost given up using it. I don’t trust it.”

Most problems, here and elsewhere, have centered on clients like Daly – low-income people who received both Medicare and Medicaid before the change.

Medicare, the government insurance plan for seniors, didn’t cover prescription drugs until a discount drug card was added in 2003. The new Part D plan replaces the discount card with a range of insurance options.

Some of the so-called “dual eligible” people didn’t get enrolled in any insurance plan, as they should have. Others who thought they were enrolled in certain plans weren’t. Some have been charged for co-payments they didn’t expect – and can’t afford.

In worst cases, some people have been denied drugs.

But state, regional and local health officials describe the problems here as minor “glitches” to be expected in an effort of such magnitude. And they say North Idaho’s relatively small population and close-knit communities have kept chaos to a minimum.

“There have been a few issues that are being resolved,” said Penny Wilhelm, regional coordinator of the state’s Senior Health Insurance Benefits Advisors (SHIBA) program. “But from what I’ve seen, this is typical Idaho. Everybody’s helped. They’ve all kicked in. Every time a problem has come in, it’s gone out.”

About 52,000 people in Idaho’s 10 northern counties were eligible to enroll in Medicare Part D, Wilhelm said. Of those, about 2,300 fall into the “dual eligible” category attracting the most concern, said Michelle Britton, regional director for the Idaho Health and Welfare Department.

“They’re the low-income folks, people with special needs, the aging, and that may be more of a problem,” Britton explained.

Like many such clients, Daly was confused by conflicting information about her new drug benefit. She was issued incorrect insurance plans and wrong insurance numbers – twice – before receiving the right card in the mail. Even then, the brain-injured woman was forced to navigate a maze of telephone menus before her medications were authorized.

“I spent five hours on the phone,” Daly said. “My battery went dead three times.”

In addition, she is worried that required new co-payments for her prescriptions could total more than $60 a month, outstripping her limited income.

“What am I going to give up?” she said. “Do I not get food for my dog? Do I not take my glaucoma medicine? What do I do without?”

Feely, the pharmacist, says he was swamped by situations like Daly’s this week. In one case, a man who expected his drug co-payments to be $1 each was stunned when they came back with $100 fees.

“Their reaction ranges from shock to disgust to ‘I can’t afford that,’ or ‘I can’t do that,’ ” Feely said. “Some people come in kind of angry, and we’re the closest person they can take a swing at.”

Feely has tried to sort out matters with government and insurance company officials, often to no avail. Long phone waits or no answers at all have been common this week, he said.

In the meantime, Feely said he has simply been filling drug requests so patients won’t leave empty-handed.

So far, he figures he has subsidized about $20,000 in drug costs. Feely expects to be reimbursed eventually by the 18 insurance plans with which he has contracted. Still, Feely said, it makes him nervous.

“We’re sending these claims into a black hole,” he said. “It’s money I couldn’t afford to lose, let’s put it that way.”

The flexibility and compassion of pharmacists like Feely have been a boon, Britton said. But she added that local and regional agencies must work hard to get people properly enrolled so that pharmacies – particularly small, private businesses – aren’t unduly burdened.

“The smaller pharmacies can’t just be handing out meds,” Britton said.

Like those in other states, Idaho’s health and welfare officials have set aside funds to pay for drugs in dire situations. Unlike states such as New Hampshire, Arkansas and Illinois, Idaho has not needed to enact emergency measures to do so. Only about 40 cases statewide have not been resolved at the regional level, said Ross Mason, a spokesman for the health and welfare department.

“Of those, only seven required that we actually pay for their drugs,” he said. So far, about $2,200 in state general fund dollars have been spent on the service.

Mason said the state’s small population and limited number of Medicare and “dual eligible” – about 17,000 statewide – made the task easier here than elsewhere.

His view was echoed by representatives from the federal government as well.

“We have not seen as many issues from Idaho as from Oregon and Washington,” said Michael Marchand, a spokesman for the regional Centers for Medicare & Medicaid Services in Seattle. “I can’t say why that is, but for this particular exercise, Idaho has stuff in place that makes it all go more smoothly.”

Frontline staff members at North Idaho social service agencies say the success depends in large part on community connections. In Boundary County, University of Idaho extension service workers have launched computer-equipped mobile units to sign up Medicare clients, one person at a time, said Carol Hampton, an extension educator.

“We’re just kind of nibbling our way through the population. We’ve done house calls,” she said. “For the most part, it’s too complex for the average person.”

The complexity of the Medicare Part D program might be another reason behind Idaho’s apparently smooth implementation, officials said. Clients can choose from among 45 insurance options with varying benefits, drug choices and payment options. Those who’ve already signed up may be among the most medically savvy and computer-literate clients. Those with lesser skills could be avoiding the issue, workers said.

“So many of the seniors, they don’t even want to discuss it,” Hampton said.

That attitude worries Leanne Rousseau, medical director for Dirne Community Health Center in Coeur d’Alene. She fears that many Medicare patients, not just dual-eligible clients, are so confused about their options that they’ll miss signing up for the benefit by the May 15 deadline. After that, clients can’t enroll again until next year, and they’ll face a 1 percent per month premium increase in the interim.

“There are so many people that aren’t even accessing health care right now,” she said. “I’m not saying it’s not a workable system. I’m saying that it’s scary right now.”