New Medicare drug program shows big problems in Vermont

MONTPELIER, Vt. --The rollout of the federal government's new prescription drug benefit for Medicare recipients has been very bumpy in Vermont, with thousands of consumers calling state officials about not being able to get the medicines they need.

"It's awful. It's an absolute nightmare," said Rich Harvie, pharmacist in charge at Brooks Drug in Montpelier. The problems have been many, he said, including a federal Medicare web site that is frequently down or offers incorrect information, and insurance company voicemail systems that automatically disconnect callers.

Judy Dow of Essex said she made two trips to the Wal-Mart pharmacy in Williston to fill prescriptions for her 83-year-old father, Robert Fortin. In the first case, the pharmacist could not find Fortin enrolled in the program but agreed to provide a small supply of pills at no charge.

When she returned and the pharmacist entered a prescription for an antibiotic to attack Fortin's bowel infection, the computer called for a $2,005 copay. "They didn't want to give me free pills" on that one, Dow said.

"To attack the community of people who are elderly with something as drastic a change as this is not right and should never have happened," she said.

A spokesman for Gov. James Douglas, Jason Gibbs, said Wednesday that more than 2,000 calls from pharmacists and consumers had come in recent days into the special toll-free number that handles inquiries related to the state's prescription drug benefit programs.

The state expanded its phone bank hours to 8 p.m. to handle the influx of inquiries, officials said. Tales of long wait times on the phone lines were legion. Dow said she was told she would get a callback in three days.

Gibbs said the administration was "working very aggressively to identify the problems and the best ways to fix them." He said the problems were national in scope and that a major one appeared to stem from problems with a computer system operated by the federal Centers for Medicaid and Medicare. Maine Gov. John Baldacci issued an order saying his state would pay pharmacy bills if people shifting from that state's program to the federal version were inadvertently dropped from the rolls.

Beth Stern, director of the Central Vermont Council on Aging, said Vermont should do the same thing. "The state should just say everybody should get their prescriptions filled and we'll figure it out later."

Joshua Slen, director of the state Office of Health Access, said the state was made aware of 746 problems being experienced by people trying to fill prescriptions under the new program on Tuesday and resolved them all.

"As far as whether it's a crisis or not, I don't think it is. There are individual situations that are very serious and need to be dealt with expeditiously," Slen said.

Michael Sirotkin, a lobbyist for an advocacy group for seniors called the Community of Vermont Elders, said while the problems extend beyond Vermont's borders they are being felt more acutely in the Green Mountain State than in many other places.

Sirotkin said that was because Vermont for years has offered one of the nation's more generous state prescription drug subsidy programs. He said state officials had been seeking to move seamlessly to the new federal system so that people who had been getting help paying for medications for years would not lose it.

"For 30,000 Vermonters, when they go into the pharmacy with their refill bottle and say can I have my Lipitor ... through no fault of their own they're not in the system through this transition period," Sirotkin said. He warned that the problems could persist for several weeks as people who only fill their prescriptions once a month or once in two months try to do so.

Some pharmacies, including Harvie's, were providing small supplies of medications to regular customers to get them through the next few days.

Harvie estimated only about 20 percent of customers who came into his store Monday and Tuesday to make drug purchases under the new program were able to have those purchases processed properly. "One person yesterday was going to be charged $1,600 for a prescription. I just gave it to her." Harvie said Wednesday morning that the customer already had called to see about squaring up the account. Sirotkin said of Harvie's estimate of properly processed purchases, "If it's 20 percent statewide, that's a disaster." He said many elders could quickly develop dangerous health problems if they can't fill their prescriptions.

Some of the problems with the program were said to be tied to its sheer complexity. The new federal system, which is expected to cost $740 billion nationwide during the next 10 years, actually is being administered by private insurance companies.

Forty-four are operating within Vermont, Sirotkin said, offering plans with a wide range of features. Eleven of those companies were chosen to handle those being shifted over from Vermont's prescription drug programs.

The new federal program offers $2,250 worth of coverage with a $250 deductible. Beyond that amount, customers must pay 100 percent up to $5,000, before the insurance begins picking up most of the cost again. Vermont has created a new program, V-Pharm, to cover the gap in the federal program.

Rep. Bernard Sanders, I-Vt., said he was backing a bill in Congress to ease the transition by allowing people to enroll in the new program anytime during 2006 without a penalty that was to be imposed on those who missed a May 15 deadline. He said the bill also would allow seniors a chance to switch which plan they had chosen if they were unhappy with it.

Sanders agreed with state officials that the problem was national in scope.

"The Medicare prescription drug program is already proving to be a nightmare to implement, causing mass confusion among seniors across the country in terms of what the true costs of each option will be, which drugs will be covered under which plans, and how to actually get their drugs covered," he said.