State begins reimbursing pharmacists for stopgap drug aid

01/18/2006

Because of problems with the new Medicare prescription benefit, poor clients had been denied the reduced prices. Many pharmacies provided them with needed drugs at no charge.

Warren Wolfe,
Star Tribune
Last update: January 18, 2006 – 8:44 PM

Minnesota on Wednesday began paying pharmacists $1.6 million for drugs they’ve given to low-income people who mistakenly were denied nearly free drugs by Medicare and their drug-insurance plans.

And that’s just the bill for 24,451 claims filed by pharmacists through midnight Tuesday.

The state denied payment on 6,193 claims. In coming weeks, pharmacists likely will seek millions more.

Also Wednesday, Gov. Tim Pawlenty’s executive council extended for 30 days his five-day emergency order issued Saturday approving the payments. State officials hope that by then, Medicare will solve problems that have left hundred of thousands of poor Americans struggling to get needed medicine.

Problems with the new federal drug benefit for 43 million Medicare beneficiaries erupted immediately when the program began Jan. 1. About 20 states so far have stepped in to help fill the gap.

Hardest hit were some of the poorest Americans, 6.2 million older or disabled Medicare beneficiaries—about 100,000 in Minnesota—whose drug costs were switched from Medicaid to new private plans offering the Medicare drug benefit.

Hundreds of Minnesotans on both Medicare and Medicaid went to drugstores in the past three weeks only to be told that the Medicare computers can’t find them or that they must pay far more than the $1 to $3 per prescription they should be charged.

In many cases, the massive and nationwide array of computer problems, bad data and overwhelmed Medicare and drug-plan phone lines prevented pharmacists from verifying that a customer was eligible for the deep subsidy—and sometimes unable to find out if that customer even was enrolled in a drug plan.

The state’s emergency action allows pharmacies to bill the state for the improper co-payments or deductibles that Medicare or drug plans mistakenly are requiring of people on Medicare or Medicaid.

“If you’re a dual enrollee [in Medicare and Medicaid] taking 12 medications a day, it’s a life-threatening situation,” said state Human Services Commissioner Kevin Goodno.

Collapse at the pharmacy

On Monday, a Minneapolis 24-year-old woman suffered a grand mal seizure in front of her pharmacist and fell to the floor because she could not get her needed anti-seizure medications in time, said Barbara Kuhn, a Legal Aid lawyer who counseled the woman.

Kuhn described that incident Wednesday to legislators meeting at the State Capitol for the latest news about the problem. The woman recovered, got her two medications and was driven home by her sister.

“The state should not be having to pay for the federal government’s mistakes,” said Sen. Linda Berglin, DFL-Minneapolis, chair of the Senate’s Health and Human Services Budget Division.

Medicare has pledged that it will help states get reimbursement from the drug plans that should have paid the costs.

Working through backlog

In the meantime, Medicare still is wrestling with computer problems and a backlog of data waiting to be entered into the system.

About 7,000 people a week continue to call the Minnesota Linkage Line for help.

But since the governor’s action, fewer people are calling in a panic saying they can’t get their medications, said Kelli Jo Greiner, a Medicare specialist at the Minnesota Board on Aging, which supervises the phone service.

So far, officials said, Linkage Line counselors have resolved problems for just 36 of the first 536 dual-eligible Minnesotans who sought help.