Drug plan troubles force third extension
The state's extension helps cover benefits for Hawaii recipients
The state is extending drug coverage for the third month for residents with both Medicare and Medicaid benefits because of continuing problems with the new federal prescription drug program.
"We're still working with the Centers for Medicare and Medicaid on some issues," said Tracy Okubo, legislative assistant to state Human Services Director Lillian Koller.
The trouble began Jan. 1 when free prescription drug coverage under Medicaid was dropped for about 26,000 islanders also on Medicare.
They were switched to the new Medicare Part D drug program, requiring them to choose among 14 federally approved plans for Hawaii offering 52 options with different premiums, co-payments and benefits.
Those who didn't select a plan by Jan. 1 were automatically assigned to a plan by the federal government.
A lot of problems occurred, such as residents assigned to plans with companies that weren't authorized to do business in Hawaii, Okubo said.
Hawaii was the only state with a plan to cover Medicare-Medicaid clients (called "dual eligibles") in case of a snafu and they haven't been turned away at pharmacies, Okubo said.
Medicare also provided transitional coverage nationally and has extended it through March 31, said Pamela Cunningham, coordinator of the Sage PLUS counseling program.
About 5,000 Medicare-only Hawaii residents have signed up for drug plans thus far out of an estimated 30,000 who might benefit from the program, she said. People are still signing up and some are waiting and studying the plans to understand how they're working, she said.
Okubo said the state's cost for drugs for Medicare recipients losing Medicaid coverage was about $300,000 for 1 1/2 months. That will be reimbursed to the state, she said.
U.S. Health and Human Services Secretary Mike Leavitt announced in a Feb. 9 news release that "Hawaii will send $2.1 million less to the federal government in 2006 because lower drug costs and strong competition have reduced the price tag for Medicare's new drug coverage."
"I'm not quite sure how they got that figure," Okubo said, adding that possibly it was based on a $10 million reduction in the department's Medicaid pharmacy costs in the two-year executive budget.
She said a team from the federal government came here two weeks ago to visit pharmacies statewide to see the problems for themselves.
They tried to process claims in the system and saw them getting rejected, she said. Also, they couldn't reach plans on the mainland because of time differences, she said.
"They were seeing problems we were telling them about ... Experiencing these first hand will help to resolve the issue versus trying to figure it out," she said.
Mack McElhaney, owner and chief pharmacist at the Pillbox Pharmacy in Kaimuki, said one of the risks for patients "is being the victim of a sales pitch" that commits them to a plan "and they discover belatedly that the medicines they are on and have been for a period of time are not included."
Patients should talk to their doctor before switching, McElhaney said.
They can change plans up to May 15 if their first choice wasn't good for them. After that, they can't change until November.
"Here at the Pillbox, we've been able to work it out fairly well," McElhaney said of the complicated program, giving "kudos" to the Hawaii Medical Service Association and Kaiser Permanente for doing a good job with their members.
Hawaii is better off than many other states because of "an ohana feeling," he said. "Everybody is looking for the same thing: a way to help each other."
FOR HELP WITH THE NEW DRUG PLANS, CALL:
» Sage PLUS, 586-7299 or toll-free from the neighbor islands (888) 875-9229.
» Medicare toll-free hotline (800) MEDICARE (633-4227) or TTY (887) 486-2408.
» AARP (888) OUR-AARP or (888) 687-2277 or TTY (877) 434-7598.
On the Net: www.medicare.gov