Medicare drug benefit: Most report no problems

Four months into Medicare’s new prescription drug benefit, more than 80 percent of seniors who have used it at least once say they have had no problems getting their medicines.

That’s according to a survey released last week by the Kaiser Family Foundation, a leading health-policy organization that has tracked the new Medicare Part D benefit since before it took effect Jan. 1.

It’s good news about the program that was launched amid widespread system glitches that caused massive confusion and kept hundreds of thousands of seniors from getting their prescription drugs at the start.

But challenges remain. Forty-eight percent of those in the Kaiser survey said they had difficulty signing up for Medicare Part D, which is offered through thousands of health plans, including more than 80 in Southern Arizona.
About 20 percent said their medications will cost more than before — about the same percentage who said they had problems getting prescriptions filled.

Medicare officials announced April 20 that Part D already has met its goal of enrolling 30 million senior and disabled enrollees by the May 15 deadline.

“I think the new drug benefit has actually exceeded everyone’s expectations,” said Scott Ptacek, a vice president of Health Net of Arizona, which offers several Part D plans. “People have figured out that it’s a good idea for them to enroll and they’ve done it.”
All 43 million Americans on Medicare are eligible for the benefit. But the Kaiser survey — conducted in early April among more than 500 seniors — found 38 percent have no intention of signing up. Another 16 percent remain undecided.
Pima Council on Aging, the local source of information and assistance with Medicare issues, thinks most people who take prescription drugs will benefit from Part D.

But many of those who turn to the council for help with Part D are choosing not to sign up, despite the May 15 deadline, said Stewart Grabel, the council’s ombudsman. Those eligible for Medicare by May 15 who do not sign up by then may face a penalty if they enroll later.

“Some are choosing not to sign up because of the complications, or because they don’t want somebody else telling them what to do,” Grabel said. “Often, it’s because they are not currently on medications and they are willing to risk the penalty. They want to wait and see what happens.”

Those who are happy with how Part D is working include Ron and Ann Skwartz of Tucson, who say their coverage is better than they had before.

They were skeptical last year. But since Jan. 1, they have spent less money on several of their medications. And drugs not covered by their health plan last year are covered now.
“We’re doing fine. We’re saving money,” said Ann Skwartz, a breast-cancer survivor who recently underwent open-heart surgery.
The Skwartzes have spent about $1,600 so far this year on prescription drugs — their costs plus Secure Horizons’ — about $100 a month less than last year.

Their lower costs are due partly to the fact that Ann Skwartz no longer takes the drug she took for five years to keep her breast cancer from recurring. She found the cheapest way to get the drug was from a Canadian pharmacy that charged about $500 for a three-month supply.

She now spends $54.80 a month on a cholesterol-lowering drug that cost her close to $100 a month last year because it wasn’t on Secure Horizons’ formulary. And Ron’s cholesterol drug soon will be available as a lower-cost generic.
The couple was worried last year about the Part D “doughnut hole” — the gap in coverage when Part D enrollees pay the full cost of their drugs. It begins when total drug costs reach $2,250 and lasts until they reach $5,100, leaving folks on their own for $2,850 in prescription drug costs.

They are confident they can both dodge the doughnut hole this year, although Ann Skwartz spends about twice what her husband spends on medication. They get quarterly statements from Secure Horizons and track their receipts to try to keep their prescription-drug spending at a minimum.

“If people don’t pay attention to what they’re spending, they can hit the doughnut hole pretty quick,” Ann Skwartz said.
Theresa Rosinski of Tucson is among the 20 percent of seniors the Kaiser survey said have had problems getting their medications.
Rosinski, 93, suffers from severe asthma and arthritis, along with other ailments. She uses eight or nine medications each day, said her daughter, Connie McQuoid, who has been Rosin-ski’s Part D navigator.

Rosinski was one of the beneficiaries whose Part D enrollment was garbled by federal computers during the first few weeks of January. Once that was straightened out, things were going well — until about 10 days ago.

McQuoid went to the drugstore to refill one of her mother’s asthma drugs, albuterol, which comes in several forms. Some asthmatics use a handy pocket-sized inhaler. Rosinski uses vials of albuterol in an aerosol machine that gives her greater relief.

The pharmacist told McQuoid that her mother’s Health Net Senior Care plan had stopped covering the drug. McQuoid went home and called Health Net, pointing out that the company had not notified Rosinski that the drug was no longer covered. Part D requires health plans to issue a 60-day notice before they stop paying for a drug.

The Health Net representative confirmed that the drug was no longer covered. In that case, McQuoid told the representative, Health Net could expect to pay for an emergency room visit the following day. Rosinski only had two vials left, and without the drug, she was bound to have an asthma attack.

The Health Net rep made some calls, then called McQuoid back to tell her the company would authorize Rosinski’s albuterol, at least until December.

A Health Net spokeswoman looked into the matter Friday and found Rosinski’s albuterol is supposed to be covered under Medicare Part B instead of the Part D program that covers the rest of her drugs.

McQuoid is just grateful, she said, that she can help her mother deal with such obstacles.
“There’s no way she could do this on her own,” she said. “Thank God I can do this for her.”

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