Medicare switch goes 'smooth' in Hawaii

But many seniors are still confused by the new drug program

See also: Stroke patient's drug costs cut to $14

Although many seniors remain confused about the new federal prescription drug program, Hawaii "led the nation in a smooth transition" for Medicare/Medicaid clients, a state official says.

"This was such a huge reform of Medicare, it's going to take a period of transition and that is happening very rapidly in Hawaii, relative to other states, and very smoothly," said state Human Services Director Lillian Koller.

Enrollment for Medicare Part D prescription drug benefits began Nov. 15, last year, and will continue until May 15. Seniors who haven't signed up for a plan by then will have to wait until November and pay an additional 1 percent per month for the premium.

Many seniors still don't understand the program, despite a number of seminars to explain it, said Jill Kitamura, director of the Senior Department at the Moiliili Community Center.

Seniors participating in an art program there confirmed this in recent interviews, asking not to be identified.

One woman said she was "shocked" when she learned $22 was being taken from her Social Security check to pay for the drug plan. Another, who was in a drug discount mail order program, said she fears her medicine will cost more.

The immediate impact of the change fell on 28,000 Medicare/Medicaid recipients who lost free Medicaid prescription drug coverage Jan. 1.

The Center for Medicare and Medicaid Services automatically assigned them to a plan if they didn't sign up for one by Dec. 31.

The state anticipated problems in the changeover and established a Pharmacy Assistance Program special fund to cover costs for the so-called dual eligible clients.

Hawaii was first in the nation with such a contingency plan, Koller said, adding that 31 other states "have copied us."

From Jan. 1 to 25, she said the state paid 16,464 co-payment claims totaling $32,690 for 5,777 people.

During the same period, the state paid 8,032 claims for medicine totaling $316,628.08 for 3,143 Medicare/Medicaid clients with no insurance coverage on Jan. 1, Koller said.

They included people who were enrolled by the government in unlicensed plans; those who were correctly enrolled but opted out of the assigned plan; people who just became eligible for Medicare at age 65 and had no time to enroll in a drug plan; and those who asked their pharmacy for a drug they had been getting but wasn't authorized under the new plan.

Koller said the federal government will reimburse the state for drug costs in the transition, as well as 70 percent to 90 percent (instead of the usual 50 percent) for administrative costs because of the contingency plan.

Noreen Moon-Ng, DHS policy and program development office administrator, led the transition team with help from Tracy Okubo, Koller's legislative assistant.

Moon-Ng said 14 plans were federally approved for Hawaii, including eight stand-alone prescription drug plans and six Medicare Advantage plans, and they're offering 52 options to compete for clients.

She said the Medicare Prescription Drug concept "was really good and still is good, but the plan sponsors weren't fully ready" and didn't adequately educate and train pharmacists in their network.

A three-hour wait for a pharmacy to connect with a plan wasn't unusual early in January, but that has improved, she said.

Pharmacist Wendell Au at Waianae Drug, 85-919 Farrington Highway, said the program "was a mess" when it began and he still hasn't received contracts from some plans.

Initially, he had to turn away some non-dual-eligible clients "because not everything was working properly," he said. "Actually, it's a good program. It just is not working right now. I just got off the phone with an insurance company I was trying to get for four weeks. They have to figure out what's wrong."

Moon-Ng said the DHS received 1,700 calls from Jan. 1 through Friday from people asking for assistance. There were few complaints, she said.

Hawaii has about 186,000 Medicare beneficiaries, but many are retirees or employees with drug coverage from past or present employers. An estimated 30,000 may benefit from the new Medicare drug program, officials have said.

Thus far, more than 3,000 have signed up for a drug plan, said Pamela Cunningham, coordinator of Sage PLUS, health information branch of the Executive Office on Aging.

Sage PLUS, which offers help to seniors in selecting a plan, is still getting a lot of calls, Cunningham said. She expects calls to pick up from people who haven't decided on a plan by May 15.

Larry Tong, manager of Gulick Pharmacy at 2070 N. King St., said pharmacists must put a lot more data into the system to fill a prescription, so it takes longer. But, he said, "it's smoother than I anticipated. ... With anything new and different, it takes a little getting used to."

He said no patients are turned away. "The state is pretty good about telling us to force it through them. ... We give them the medicine, no matter what."

Mary Rydell, federal Health Care Financing Administration regional administrator in Hawaii, commended the state and pharmacies for averting the situation that occurred Jan. 1 in some states in which Medicare/Medicaid recipients weren't able to get their medicine.

Hawaii officials were afraid low-income residents with many prescriptions would walk out of a pharmacy without drugs, even with a small co-payment, she said. So a lot of planning was done to prevent that, she said.

"The state worked so hard to get information out in December to pharmacies, saying, 'If all else fails, we will pay the whole bill. We just don't want people walking out without drugs,'" Rydell said.

Pharmacists also "went way out of their way" to deal with the new plans and help confused and frustrated customers get their medicine, she said.

State agencies and organizations also worked with special groups, such as HIV/AIDS and mentally ill people, to make sure they were signed up for drug plans, she said.

"We're small, but everybody realized what an impact it (the program) was going to have on clients," Rydell said.

DENNIS ODA / DODA@STARBULLETIN.COM Richard Carlson, 65, takes care of his 85-year-old mother, Dorothy Boody, who had a stroke four years ago. Under the new Medicare drug plan, Boody's medicines cost only $14 a month, down from the previous $200 monthly cost.

Stroke patient's drug costs cut to $14

Richard Carlson of Palolo was surprised and delighted when he recently filled four prescriptions for his 85-year-old mother under her new Medicare drug prescription plan.

"It's a feel-good story," said Carlson, 65, a budget supervisor in the state Department of Human Services.

He said the four medicines had previously cost more than $200 a month. The bill under his mother's new AARP Medicare prescription drug plan was $14, he said.

"Isn't that great? I was so happy. It didn't really settle in until I paid $14 and walked away."

Carlson said his mother, Dorothy Boody, "was happy too."

She suffered a stroke four years ago and takes a number of different prescriptions, he said. Her right side is affected and she is a wheelchair but her mind is sharp, he said.

Medicare sent her a form to fill out for the prescription drug program, and he went to the Medicare Web site and followed directions to help her choose a plan, he said.

He said the AARP plan was No. 1 on the list as appropriate for his mother, so he signed her up in early January. It became effective Feb. 1. She pays no monthly fee and no deductible and the prescriptions were only $2 and $5, he said.