Emergency Prescription Coverage for Medicare Drug Benefit

The problem legislators are addressing concerns so-called dual eligibles, those who receive both Medicare and Medicaid health insurance.

About eighteen thousand New Hampshire residents fall into this category.

Before January first, Medicaid—the health insurance program for the poor—used to pay for their prescription drugs.

The plan was that after the New Year, Medicare—which is health insurance for those over sixty five—would take over.

But the transition has been less than smooth.

Scamman: Basically, it’s something that we feel is an emergency. Our New Hampshire people would have been getting very ill or maybe even dying.

That’s House Speaker Doug Scamman speaking to his colleagues at the emergency legislative session.

He’s referring to those situations in which people have showed up at the pharmacy, asked for their prescriptions, and found themselves either facing unaffordable co-pays or not in the system at all.

Don Messina, a pharmacist from Bedford, has witnessed to this problem since day one.

He said he’s had to turn away about half of the people who came to him for prescriptions.

Messina: And they need their medication, this is chronic medication, this is diabetes, this is asthma, this is hypertension, this is depression, and all of a sudden they’re shut off. OK? And they don’t get anything.

Much of the problem stems from a lag time in the switch from Medicaid to Medicare.

Dual eligibles were automatically transferred from Medicaid to one of the forty two Medicare plans offered in New Hampshire.

Problem was, the plan assignment was random.

And about half of these people switched plans at the eleventh hour to get one that better covers their prescription needs.

Medicare spokesperson Roseanne Pawelec says it overloaded the computerized enrollment system.

Pawelec: What happened was the computer information was not being uploaded into the system fast enough at the tail end at the break between 2005 and 2006 so that when the person went to the counter early in January the computer systems were not reflecting their changes in their plans.

Ellen Curelop says she’s been getting about twenty five to fifty calls a day from people in this situation.

Curelop is the President of Life Coping, which manages cases for about seven hundred fifty dual eligibles.

She says fixing the situation for her clients has not been easy.

Curelop: We try to call the plan, but it’s impossible. One of the big problems is communication. We’re unable to get the information because we’ll get messages like: due to overwhelming response to our plan we’re unable to field calls at this time, please call back, and they hang up.

While communication lines and computer systems are tied up, the emergency legislation has allotted up to five hundred thousand dollars to provide coverage for the estimated three thousand individuals in need.

Representative Tom Donovan is pleased that lawmakers, the Governor, and Health and Human Services recognized the seriousness of the situation.

Donovan is a case manager for people with Medicare and Medicaid.

He says he has visited all but two pharmacies in Sullivan County and all of them have struggled to fill people’s prescriptions.

Donovan: I feel that probably in a lot of people’s eyes there was a test period and it is unfortunate that the test this thing was field tested on the backs of the poor and the kinks will be worked out over the next five or six months, but at what cost?

The Department of Health and Human Services expects that insurance companies will reimburse the state for much of the emergency coverage.

But the state might end up with some administrative expenses.

HHS predicts kinks in the system will be eliminated in the next few weeks.