Nevada County Picayune and Gurdon Times Newspaper Archive

Medicare changes confusing for everyone involved

Changes in Medicare are being compared to a maze which only has an entrance that closes once a person enters with no way out.

Nationwide there are more than 40 different plans, each paying for different medications. In Arkansas, this number is technically 14, but is causing headaches for local pharmacists.

Gary Lewis, pharmacist at Hollys Health Mart, said there are a lot of problems with the new plan. The biggest one being insurance companies were not prepared when the plan was implemented.

Another headaches for pharmacists, he said, is there isnt enough help for us. When calls are made to see if someone is in the system, the caller is put on hold. In one case, Lewis said, one of Hollys employees was on hold from 11 a.m. until 5:15 p.m. at which time they were disconnected. At no time did they ever talk to anyone.

People are being told different things, he said. Theyre told their co-pay is one thing, but when they come in, they find out its something else. Its being laid off on us. Medicare fraud is all it is.

According to Lewis, the new plan will be good for some people, but costly for others. Its confusing all around.

If a person eligible for Medicare doesnt sign up by May 15, 2006, they will be penalized 1 percent a month until they do, he said. If they have to sign up after May 15, they not only have to pay the penalty, but must wait until 2007 before their plan goes into effect. In the interim, they are required to pay full price for medication.

The real problem, Lewis said, is with the nursing homes. Residents, in some cases, have been receiving a months supply of their prescriptions at a time, called cycle fills. Sending a months supply at a time is more efficient. However, under some plans, only 30 days of some medications are paid for.

Diana Wilson, pharmacist at AllCare, said the changes are confusing to pharmacists and patients alike because of the different plans and options available.

Some of the plans are similar, she said, but people dont know which one is best for them.

Another problem, she said, is people not being in the system, though theyre told they are. Everyone was supposed to be in the system by Jan. 1, 2006, she said, but this wasnt the case. People arent getting their cards, or they think theyre on one plan and find out theyre on another. There are all kind of glitches (in the program).

I wish theyd done it a little at a time because there are more senior citizens not than ever. I hope it fixes itself once everyone is in the system.

Lewis said all of the plans are different and have three or four choices in them. In some instances, the differences are based on deductibles.

There are formularies for what drugs are on different plans, he said. People can call Medicare or go online to research the plans and see whats best for them. Those who dont choose a plan will have one picked for them at random. This, he added, may not be the best plan for them.

In addition, a person may not be able to get all the medication required on one plan. In such cases, they have to pay full price for those not on the plan.

In essence, Lewis said, Medicaid no longer exists, its all Medicare. However, some medications are still being paid under Medicaid for those eligible for both. Such people are considered dual eligible.

What makes things worse is pharmacies cant bargain with drug companies for lower prices or they could be charged with the crime of price fixing. Neither can the government bargain with drug companies.

They (Congress) could have done it like food stamps, Lewis said. Food stamp recipients are given a debit card with a fixed amount, like calling cards. The recipients then use the cards like credit cards to purchase foods.

Congress had a chance to do something decent for senior citizens, Lewis said, but they blew it.