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Archive for Friday, January 27, 2006

Drug frustrations mount

Prescription plan causes headaches

January 27, 2006

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Ed Shaw says his experiences with Medicare Part D can be summed up in one word.

"Hell," he said. "That's what it's been: eight weeks of hell."

Shaw is among thousands of older Kansans who are trying to cope with the federal government's new prescription drug program, which pushes Medicare recipients to align themselves with a private insurance plan with the promise of lower drug costs.

Here's what happened when the 79-year-old retired Kansas University biology professor tried to enroll himself and his wife in the program. Others in Lawrence and across the nation have described similar difficulties.

Shaw enrolled his wife, Cynthia, 70, in a prescription drug plan run by WellCare Health Plans Inc. He enrolled himself in a Humana plan.

"I've called WellCare five times and all I've ever gotten is B.S.," he said. "I called them December 14; they said they'd mailed an ID card. I called them December 26 to say I didn't get it; they said they'd call me back in two or three days. They didn't.

"I called them a week ago and really made a fuss," Shaw said. "They set up me with a conference call with them and Medicare. It turned out someone on their end had gotten the Social Security number wrong," he said. "It's always something different."

Afterward, a WellCare representative called with another problem. Cynthia, it appeared, was enrolled in two plans. She can only be in one.

"So I called Medicare," Shaw said. "They said she wasn't in any plan, much less two plans!"

Tuesday evening, someone with WellCare called to say everything had been taken care of. Shaw was encouraged to fill his prescriptions the next day.

"I just came back from (Round Corner Drug, 801 Mass.)," Shaw said Wednesday. "It didn't work."

Humana, he said, has been a little better.

"First, they sent me a letter, thanking me for joining Humana HMO," Shaw said. "So I had to tell them no, I wasn't in their HMO. I just wanted the prescription drug portion.

"And then, after we got that straightened out, they sent me a drug-formulary chart for Arizona with a list of all the pharmacies that would fill my prescriptions in Arizona."

The good news: Humana approved Shaw's prescription purchase, using the Arizona formulary.

"The whole thing is just a mess," Shaw said.

'A fiasco'

Shaw is hardly alone.

"As of this morning, I probably have 10 patients who still have problems. Their prescriptions won't go through," said Marvin Bredehoft, a pharmacist at Medical Arts Pharmacy, 346 Maine.

"I had one company tell me they would mail - not fax - a form to a patient's doctor's office. I said, 'How long will that take?' They said five days.

"This was for a patient who was standing right there!" Bredehoft said. "It's been very frustrating. All you can do is try to help in any way you can."

Frustrations over signing up for Medicare Part D aren't limited to Lawrence.

"It's been a fiasco," said Jack Tebow, pharmacist at Ray's Pharmacy in Quinter and president-elect of the Kansas Pharmacists Assn.

Seniors listen to a description of the new Medicare Prescription Drug Coverage options at recent informational meeting at the Douglas County Senior Services. The meeting offered by the Senior Citizen Health Consultation of Kansas to help explain the plan and what options are available for those elgible.

Seniors listen to a description of the new Medicare Prescription Drug Coverage options at recent informational meeting at the Douglas County Senior Services. The meeting offered by the Senior Citizen Health Consultation of Kansas to help explain the plan and what options are available for those elgible.

"People are being told to go online, even though they don't own a computer," Tebow said. "Then they're told to call an 800 number, and all they get is a machine. Then they come to me for help, but it's illegal for me to advise them. They call it 'steering.'"

Assistance available

But there is help. Douglas County Senior Services, 745 Vt., has been offering free Monday morning seminars on Medicare Part D since mid-November. One-on-one sessions are available by appointment.

"All we ask is that you come to one of the informational sessions before you make an appointment. It's not mandatory, but it's preferred because the session may tell you what you want to know," said Katie Glendening, a community service program assistant.

Glendening and other workers help senior citizens sort through the 41 prescription drug plans available in Kansas.

Each plan is designed to attract different groups of seniors, depending on their age, income, health, pharmacy participation and the drugs they're taking.

At Senior Services, Glendening guides seniors through a Medicare computer program, called "Plan Finder," that ranks which plans best meet their needs.

"We print out a list of the top three," Glendening said. "You can choose one and we'll help you enroll right then or you can take it home and do it yourself.

"We prefer that you take it home and do it yourself because we don't want it to look like we're telling you which one to choose," she said. "But if you want to enroll right then, it's OK."

It's become obvious, Glendening said, that many seniors do not have access to a computer or are uncomfortable entering their personal data.

"We understand," she said.

But once a senior - Shaw, for example - enrolls, they're on their own.

"They can call me and I'll do what I can," Glendening said, "but a lot of it's going to come down to them, their pharmacy and their plan."

Answers don't come easy.

"You're supposed to call these 800 numbers. You never talk to a human being; it's one machine after another," Shaw said.

Glendening noted that of the eight companies that offer Medicare Part D plans in Kansas, only one - Humana - has a representative stationed in Lawrence.

Glendening and Shaw agreed that for seniors hoping to speak with a live plan representative instead of a recording, 20-minute waits are commonplace.

Connecting with a live Medicare representative takes even longer. "An hour is not unusual," Glendening said.

Seniors have until May 15 to sign up for a plan. Those who don't will be subject to higher premiums when - or if - they do enroll.

"I've been telling my relatives to wait until April," said Dennis Grauer, an associate pharmacy professor at KU Medical Center. "A lot of these problems, I think, will be taken care of over time. This is a case of the feds trying to do too much all at once. Everybody wants the quick fix."

Grauer, who has a doctorate in pharmacy administration, warned that the enrollment problems soon may be overshadowed by availability problems.

"What the pharmacies are worried about is that some of the formularies are coming in at less than what they can buy the drug for," he said. "That cannot continue."

Eventually, he said, plans will be forced to adjust their premiums - neither of which is likely in the short-term - or "ratchet down" rates paid to pharmacies.

"When than happens, a lot of your independents are going to be forced out of business, especially out in the western half of the state," he said. "Then what do you do?"

Comments

Mercat 8 years, 11 months ago

Poor old welfare queen. He and his wife are getting a benefit which my children will be paying for for decades and all he can do is whine about it. I'm really tired of old people thinking that they are entitled to the government taking care of their every need. It was policies like this that turned my mother into a welfare queen saying, "I don't want to be a burden on my children." I pointed out to her that her children were paying much more in social security and medicare than she was receiving and that her grandchildren were next. She never quite understood the concept.

We're moving into an era when the people who work will not be able to support all the people who expect to be taken care of by the government. It's already happening in Europe and it's also happening in this country in the car manufacturing industry. The new workers are getting laid off because the companies can't afford to keep paying them as well as pay the huge bloated pensions of their retirees. I suppose that's Bush's fault too.

blessed3x 8 years, 11 months ago

I'm from the government and I'm here to help.

RonBurgandy 8 years, 11 months ago

Insurance companies have always been a big giant pain in the you know what.

I doubt that the list of people on medicare is comprised of only people who ate too much McDonald's and/or smoked forever. It's funny that your question asked how arrogant people can be...

Ragingbear 8 years, 11 months ago

You ever notice how the pro-bush supporters all say that we should let people die? Whether homeless, elderly, suspected terrorist, children. Let them die so we don't have to take care of them.

Makes me sick.

christie 8 years, 11 months ago

Here's the real kicker. Once you sign up with one of the plans, you can't back out, but the companies providing the drugs can discontinue it. Then you're stuck with nothing.

I thought the Republicans were about Less Government. But all I see out of them is More Government.

badger 8 years, 11 months ago

Yet again, the federal government screws something up and local individuals and agencies get to bear the brunt of dealing with its effects. Every President for decades has inherited a screwed-up system of social welfare prone to abuse by some and failure to help others in need, and every President has somehow made it even worse. Medicare Part D is just the latest in a long line of screwed-up federal revisions of the system.

All debate on the merits of Medicare aside, the program should work right if it exists. If you tell people they'll be able to go to the doctor, and get necessary medications for continued breathing, then you need to back that up.

The federal government, every time it breaks something, says, "We're fixing that, and help is on the way." They just don't have the trust and credibility that will let me believe them when they say that, no matter what 'side' they're on.

bluerose 8 years, 11 months ago

curious about the ugliness of some of the comments. i, too, am a bush-despising liberal, but wow... have some compassion, people.

many of these people being shafted by these new medicare changes have probably been working for 50+ years, incomes siphoned out, paying their taxes, being promised care in their retirement - and now? ha.

also, mcdonald's was probably not a food staple in their youth, and the issues and trickery of smoking were not yet exposed. if you want to gripe about "Lazy, fat A$$ed pieces of $&it.", perhaps direct it at those more deserving. for they are surely out there.

sonny 8 years, 11 months ago

Well I work for the goverment and I'm also here to hlep not to hurt. Alot of what Pork Ribs said was true but for every 10 lazy smoking, drinking spam eating people that are suckng what they can from the goverment thier is that one person that was born with deities and drugs for them are vital. Along with the person born with a heart mumor or just got old took great care of them sleves all thier lives. What about the service man that severd in the gulf war that caught somthing that gave him cancer and he died, these drugs are needed. And yu can't always blame people because they don't know what they do is wrong some know and choose not to change your right ribs they will fail. But alot of this is due to miseducation to sell a product for the rute of all evil. Should people let the wicked or the uneducated die it's a great debate but also a sad reality.

badger 8 years, 11 months ago

'born with deities'?

I'm sorry, sonny, I have no idea what that means.

And bankboy?

Ain't about socialized medicine, sweetcheeks.

It's about 'you put a thing out there, and it doesn't work, and you spent a truckload of my money to set up something that's made people worse off than before, and now you're going to want another truckload of MY money to fix the effects of YOUR mismanagement of my money in the first place.'

bankboy119 8 years, 11 months ago

This comment was removed by the site staff for violation of the usage agreement.

RonBurgandy 8 years, 11 months ago

wendt:

If it hasn't happened yet, I doubt there is any chance of hope...

Linda Aikins 8 years, 11 months ago

I very much take offense to your attack on seniors. most of them did put their share of their incomes into the government banks during their years of working.

Mayor McGrumpy and his cousin Randy apparently are on this board today.

RonBurgandy 8 years, 11 months ago

Nice gootsie,

Mayor McGrumpy, I think that is a step up from Mr. McGrumpy!

RonBurgandy 8 years, 11 months ago

As long as they can make their money...

Linda Aikins 8 years, 11 months ago

I apologize for pointing out two people who simply have differing opinions and experiences than I. It's difficult for me when posters are so incredibly radical and negative.

Sorry!

RonBurgandy 8 years, 11 months ago

There is no harm in referencing two posts on a public message board.

badger 8 years, 11 months ago

wendt - I think 'Mayor McGrumpy' was a McDonald's reference (Mayor McCheese), not a reference to actual government in Lawrence, which wears striped pants a lot less often but still sometimes has a head full of pickles.

bankboy119 8 years, 11 months ago

Wendt, what countries are you saying have better healthcare than the US? Briton's healthcare is in all kinds of trouble and France is in even worse shape. We are the envy of the modern world but because of Dems like you we will not continue to be.

Ragingbear 8 years, 11 months ago

Bankboy,

My party? Who said I was a democrat? I have voted for republicans, independants and democrats in the past. But your narrow view is that there are only two ways to go in politics, either extreme left, or extreme right.Republican, or Democrat. What about independants? What about Libertarian, Green Party, or other lesser known parties?If you claim that it has always been this way, then you don't know your American History, as many early presidents were from now defunct and dead political parties. Many times, people like you try to vote for a person because of their stance on one issue, and completely ignore that other issues at hand. Republicans commonly use the abortion argument. Make it illegal, and hello coat hangers. We know that from history.

As for my views on it? I think that it's wrong, personally. But at no time would I ever dream of trying to deny that choice to anybody. It is actually YOUR party that is to blame for the vast amount of abortions. With your abstinence programs that DO NOT WORK, we get plenty of unwanted pregnancies. Your party instead chooses to wait and send them off to wars started for unfounded reasons, and poorly equipped, while the rich kids in the military are made officers that get to sit in air conditioned bases back in the states. Your party pulls healthcare, education, social security funds, as well as welfare. This results in a rise in prostitution because people can't figure out any other way to survive in the ghettos of the US. Once again, unwanted pregnancies.

Not to mention that this is a thread about healthcare, not abortion. You are wanting to deny people healthcare that they were promised, and that they worked for and paid taxes for most of thier lives. You want to deny it to veterans, and those who are unable to work because of disabilities. And believe me, there are a signifigant number of disabled people who would rather work, but can't. But you just see people abusing the system, instead of the other 98% that are legit. You want to tell people "Get a job" but for some reason, the Republicans think that a bad economy is good for America because it makes the Dow Jones go up. Yeah, it's good. For thier corperate buddies. The lack of jobs then contribute to ALL the other problems you complain about. So stick it.

And that was a low blow, and a diversion tactic that you used. Typical republican, once again trying to avoid the issues instead of facing them.

Liberty 8 years, 11 months ago

If people are disgruntled with the welfare system, blame Congress, not the Bush admin... Only Congress and it's slick lawyers sets up laws and the welfare system through the social security system (and traps you in this system). President Bush makes no laws. Congress is the one that made this mess. (Not that I really support the Bush admin., but he is not the author of the welfare mess, Congress is the guilty one that tricks us into the social security system...

Confrontation 8 years, 11 months ago

Sonny-Please don't tell me that you hold a decent job with the government! Apparently, you don't hold a job that requires you to write.

Linda Aikins 8 years, 11 months ago

Thanks Badger for 'splaining that for me!

Ragingbear 8 years, 11 months ago

If you put much more white space and such in there, then the message would end up exceeding the allowed limit. That is the reason the message was posted that way.

badger 8 years, 11 months ago

ragingbear said:

" You are wanting to deny people healthcare that they were promised, and that they worked for and paid taxes for most of thier lives."

You know what chaps me most?

I know right now that there's a good chance that healthcare won't be there when I need it, though I'm also being promised it and I'm paying in for it. I'm paying Social Security because of the government's blithe assurances that the program won't go under, but there's not a whole lot of reason behind their assurances that I'll have that support when I turn 65.

I don't mind paying in to cover people now, but I wish the government would just dispense with the premise that I'll ever see Social Security myself.

badger 8 years, 11 months ago

Huh?

I just asked sonny what the heck 'born with deities' means. Is it like Julian of Norwich or Joan of Arc, having god in your head and getting holy visions?

laughingatallofu 8 years, 11 months ago

This comment was removed by the site staff for violation of the usage agreement.

Ragingbear 8 years, 11 months ago

That is true badger. The Social Security system is heavily flawed, and needs a complete overhaul. Some say privatize it, others say to modify it. I am not really sure, but we do know that we are already sucking out the bottom of the barrel on it.

Ceallach 8 years, 11 months ago

As an employee of the great State of Kansas, we are given the choice of ONE prescription plan, and the company has the option to make changes in the formulary ever-when they please. Unfortunately, this is not a rare occurence.

It would relieve some posters' stress if they would learn the difference between Medicare and Medicaid. Having done that, please rave on :)

wonderhorse 8 years, 11 months ago

..."and poorly equipped".... This absolutely isn't true. There is a fuss about the Hummers not being armored, but they weren't originally designed as an armored vehicle. The US soldier is the best equipped in history. The Roman soldier came close, but is still second best.

laughingatallofu 8 years, 11 months ago

Sorry. I crossed the line. My apologies to badger, sonny and everyone else.

RonBurgandy 8 years, 11 months ago

It really sucks when you miss a post that was removed and others talk about it...

hip_gma 8 years, 11 months ago

My best advice is make a list of all Rxs and dosages and find someone who can get on the internet if you or the participant can't. Follow the steps and it will ask you to type in each Rx, dosage, etc. Then it will give you a listing of Rx plans, starting with the least expensive over a year's time. You'll need to consider the lack of coverage in the gap period. However, if midway through the year your Rxs change then you're still stuck w/ that plan until year end.

Jillster 8 years, 11 months ago

Keep in mind that Medicare is NOT welfare. It's not assistance for the poor, like Medicaid...it's a federal health insurance plan for people age 65 and older. Everyone pays into it with deductions taken out of their paychecks, and most working people will automatically be enrolled in Medicare when they turn 65. Doesn't matter if you're filthy rich or dirt poor...Medicare eventually comes in to most people's lives, if they're lucky enough to live that long.

Confrontation 8 years, 11 months ago

Ceallach-I used to work for the State, and I really miss their insurance. It was $15 per month, for health, dental, and vision insurance back in 2004. Now, my current employer wants $185 per month for health only, $20 for dental, and don't even ask about vision. That $185 for one person. I'm young, and have no rare diseases or history of anything. I realize the prescription plan frustration, but really be glad that you don't work for private nonprofit!!! I sure miss having insurance...

Confrontation 8 years, 11 months ago

Wendt: Take a look at Sonny's previous posts. The one on September 17 at 8:08 a.m. is a good one. If this post is satire, then the rest must be satire.

BunE 8 years, 11 months ago

Emperor George has created, bullied and embarked on a plan to pander to senior citizens and at the same time bankrupt the feds. It will be a grand time!

Those dang sick people, why won't they die instead of using our glorious pharmaceutical company's work product. In fact we are so comfortable with the wisdom and experience of the drug companies that we trust them to give us the best prices and give up any option of negotiating with thm.

Yay America

Ceallach 8 years, 11 months ago

Confrontation, I've had my eyes opened more than once when I heard about some of the really poooooooor insurance coverage people receive from their employers. I've also heard that medical offices are some of the worst offenders when it comes to palming off weak insurance plans as a "benefit" for their positions. What you wanta bet the "medical professional" has much better coverage than their employees?

yourworstnightmare 8 years, 11 months ago

Wow.

I didn't read the whole blog but some of the posts from Porky, Spankboy, and others were really extreme and nasty. I'm sure their mothers would be proud of them, not to mention that a$$hole Jesus who was all about disregard for the sick and poor. Spankyboy, Porky, you should be ashamed of yourselves.

Confrontation 8 years, 11 months ago

Ceallach-I totally agree. My mom works in a nursing home and the insurance would take out too much from her check. I left my job with the state so I could quit my Topeka commute. I didn't realize how much I'd miss the insurance. My current job did call their health plan a "benefit," although I could get about the same coverage from AffordaBlue for $85 per month, rather than $185.

Charles L Bloss Jr 8 years, 11 months ago

Wait a minute, I am a republican, and supporter of our President. I never, ever said anyone should die, except when our Lord calls them home. Be very careful of using the word "all"! I recognize that this whole Medicare Part D fiasco is screwed up. I have waited on hold for hours and have made no progress toward understanding it, or enrolling in it as of yet. I do not want any person to do without their medicine, or die because of it. Thank you, Lynn

KsTwister 8 years, 11 months ago

Can someone tell me what to tell some of the seniors who won't sign up and won't take their medicines either? They are extremely frustrated and sickened because Medicare D takes costs out of their checks they worked so hard for and some who have retirement medical plans have raised their premiums by the same amount also. Can you sue the government for wrongfull death?? I am not kidding.

wonderwoman 8 years, 11 months ago

Let's put a personal face on this medical fiasco, the medicare prescription plan as experienced by someone who needs the meds for survival.

I am a relative of a medicare recipient who was standing at the counter of Medical Arts Pharmacy when told by Marvin of no medicine without prior authorization. We had both been on hold on the phone most of the morning waiting for a real voice when refused immediate solution to an urgent problem.

Here's the situation....the doctor prescribed an antibiotic for an infection and a med that prevents a secondary infection(this patient has a history that requires this protocol). The new medicare insurer covered the antibiotic but required prior authorization for the preventative med.

The insurer's procedure is to mail, not fax, the preapproval forms to the doctor who fills out and returns the forms to the insurer before the pharmacist can issue payment. All of which takes a minimum of two or three weeks if all goes well.

What would have been a co-pay charge wasthe full amount of the drug. This situation called for immedicate consumption of the prescribed drug(previously covered without question).

Also there was another drug prescribed not covered that had been previously covered. We had to pay the full amount on that one too.

Next, it was time to renew the normal monthly prescriptions on that same day. The pharmacist had to deny insurance payment on a regular prescribed drug which is addicitive because the insurer didn't cover the entire class of drug.

This drug has been a part of the clients treatment for years. We had to pay for it also or risk the severe effects of withdrawal that most likely would have resulted in hospitalization for an extended period of time while withdrawal and attempted substitutions were made. Something that has proven ineffective in the past.

We paid the full amount once more due to poor and dangerous choices in the matter.

What would have been co-pays on these three drugs of $1-3 each ended up costing us close to $90. The co-pay was in the budget but we are in a hurt to figure out how to come up with the money for this past month as well as the on-going expense.

Not to mention the extreme time and effort put in by the pharmacist, the doctor's office(we have difficulty enough getting apointment times without this extra time consuming situation for Dr. and staff), additional time researching alternatives that don't seem to exist, time with the doctor to attempt an appeal for future use of known effective prescriptions, serious finacial stress to meet the needs of this individual without sacrificing food, utilities, fundamental daily needs.

Wonder why our health care is not funded while an undeclared war for false reasons is funded? How many Iraii's or Afganistani's have paid into the SSI system?

wonderwoman 8 years, 11 months ago

SHE? Please, no assumptions. This can and does happen on a non-gender specific basis. Prayers always appreciated but please contact your state and federal representatives to voice righteous indignations.

While waiting on the phone for a live person to reject our medicine requests there were many other coverage problems for other medicare recipients.

What really stands out is the pale stresssed out looks on the pharmacy's staff and waiting customers while this fiasco took place before their eyes, not knowing what trauma awaited their requests for drugs, customers waiting on hold for Marvin so he could TRY to resolve as many issues as possible only to get voice mail or cuts offs because of phone traffic overload.

There is no fair compensation for the extra work the pharmacists and doctors are put to for their efforts in this fereral farce.

Are we ready to bring war on another nation? I still can afford to eat frugally. There must be a way to depleat that part of our budget.

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