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If a person is on a medicaid program which at least one of theses
patients was, then she/he would have automatically been enrolled into a
Medicare plan D drug plan. She/he would have gotten a letter stating
what program the govt. put her into. The problem is the patient has to
open the letter from the govt.  No joke.   Secondly, the problems were
that the govt. just randomly put the person into a drug plan without
checking to see if the drug plan covered that individuals drugs and some
people weren't put into the policy/plan in a timely matter.

nancy m
unedited

rayilynlee wrote:

> It's enough to make them sick
> On Jan. 1, the new federal prescription-drug benefit took effect.
> Untangling
> the complexities of Medicare Part D has been frustrating and
> time-consuming
> for many beneficiaries, and some have struggled to get the plan to cover
> crucial medications. Here are four people's stories.
> March 26, 2006
> Bait and switch
> Jerry Warren
> AGE: 70
> HOME: Salem, N.H.
> MEDICAL CONDITION: Had a quadruple cardiac bypass operation in 1994
> NUMBER OF PRESCRIPTION DRUGS: 11
> COVERAGE OVERVIEW: One of his cardiac drugs isn't covered because
> Medicare
> classi? es it as a prescription vitamin.
> Jerry: I had a quadruple bypass in November 1994. I never had a heart
> attack -- my problem was angina, and my symptoms were a feeling of
> weakness
> in my left forearm and I get slight nausea. One of my medications is
> Niaspan. It's an extended-release form of niacin, and it helps reduce
> triglycerides and the bad cholesterol.
> Donna: It keeps you from having a heart attack.
> Jerry: I had been getting prescription coverage from Blue Cross
> Medigap Plan
> J. I could have stayed on it, but it's not considered equivalent to
> Part D
> coverage by Medicare. That could have left me vulnerable to paying
> penalties
> if I switched later to a Part D plan.
> Donna: We searched on the Medicare website to find a drug plan that would
> cover all of Jerry's medication. We joined AARP Rx, the plan run by
> United
> Healthcare. When we signed up on Dec. 6, Niaspan was on the formulary. We
> even called up and confirmed with an actual human being at AARP Rx
> that all
> of Jerry's drugs were covered. The first clue we had that Niaspan was not
> covered was when the pharmacy called.
> Jerry: In mid-January I dropped off a prescription and got a call two or
> three hours later. They said Niaspan wasn't covered and it would cost me
> $174 a month.
> Donna: I got on the phone to United Healthcare and he said he received
> notification that Niaspan had been removed from the formulary on Jan. 6.
> Medicare made the decision that it was considered a vitamin, not a drug.
> Jerry: You have no guarantee that your drugs are going to remain on the
> plan, and you're only allowed to change your plan once a year. We have
> shelter, we have food, and the extra expense for this medication isn't
> going
> to take that away from us. But what happened is so inherently wrong.
> Donna: Do you know what this is? It's a bait and switch.
> Left adrift in the system
>
> Terrie A. Slater
> AGE: 45
> HOME: Salisbury
> MEDICAL CONDITION: Disabled since brain tumor surgery in 1999
> NUMBER OF PRESCRIPTION DRUGS: 8
> COVERAGE OVERVIEW: Automatically shifted from Medicaid to Medicare;
> having
> difficulty receiving coverage for all medications
> Before I was diagnosed with my brain tumor in July 1999 I didn't take any
> medications, aside from birth control pills. Now I have a bowl full of
> meds.
> Until January, I was getting my prescriptions from MassHealth, and I
> never
> had a problem. I would pay a $1 or a $3 copay.
> When Medicare Part D came, I just assumed I didn't need D -- I had
> MassHealth. They didn't make it clear that I had to enroll in a plan.
> I never got any literature. They should be able to put it in terms I can
> understand. Now I'm not sure who covers my prescriptions. I bring a
> prescription to the pharmacist, and I pray they cover it.
> In January, I ran out of my seizure medication. I went without it for
> a day.
> I was starting to get throat seizures -- contractions of the throat
> that are
> a precursor to full-blown seizures. If I have a seizure, I won't be
> able to
> drive for six months.
> Now I'm getting by on samples from my primary care physician. She
> gives me
> samples of my antidepressant, Lexapro. It isn't covered under Part D.
> I take
> it because it works. These are all the same meds I've been on since 1999.
> I'm trying to keep calm, but I'm in a situation where I have to choose
> between paying my rent or getting my medication.
> I get a disability check for $735 a month. The rent here is $355. Last
> week
> I had to buy one prescription out of pocket and it cost me $80. If I
> don't
> have that drug I won't sleep for three or four days straight.
> I just got an eviction notice. I'm not really sure what I'll do. I go to
> food pantries. I'll figure something out. I feel as though I got left
> out in
> a dark alley.
> Nickeled and dimed
>
> Johnn O'Sullivan
> AGE: 67
> HOME: Roslindale
> MEDICAL CONDITION: Effects of a heart attack and arrhythmia
> NUMBER OF PRESCRIPTION DRUGS: 7
> COVERAGE OVERVIEW: Can't coordinate the
> components of his coverage despite seeking help from various insurers and
> agencies
> In November I developed a heart arrhythmia, and then I had a small heart
> attack. I went to the ER four separate times.
> Then I chose a Medicare drug plan. Choosing the plan was a major
> adventure.
> It took me four solid days. I chose Blue Care, and I still have
> Massachusetts Prescription Advantage as a secondary payer, which picks up
> anything that's not covered by Blue Care.
> But since then, I've kept on having billing problems. I'm unable to
> get my
> pharmacy to succeed in billing Prescription Advantage as a secondary
> insurer. They can bill one or the other, but they can't bill both of
> them.
> They've tried.
> I got billed in February, but for the wrong amount. They billed me $28.64
> rather than the $20 premium. I just paid the full amount, and
> Prescription
> Advantage is supposed to reimburse me later. I just got an April bill,
> and
> it's still $28.64.
> All this has taken me the equivalent of six days. Every time I made a
> phone
> call I was on hold for an hour. It was a tremendous burden. I was
> involved
> in actuarial work, so this kind of thing is right up my alley. But it
> took
> an effort to understand this new plan.
> But the design of the benefit is a real disaster. Give people enough
> choices
> and it's paralyzing. Then there's the fact the pharmaceutical companies'
> prices are protected. And when you finally sign up for a plan, it doesn't
> establish a binding contract on both parties. The drug plans can
> change the
> formularies any time they want.
> I've never seen anything that generates so much red tape. I think
> about all
> the people who don't have the mental sharpness to do this. Sometimes I
> think
> Medicare Part D is a secret government plan to improve the mental
> acuity of
> seniors by giving them all of these word problems and arithmetic.
> High-stakes runaround
>
> Wayne Bailey
> AGE: 58
> HOME: Newton
> MEDICAL CONDITION: His disabled son, Bryan, 28, suffers from kidney
> failure
> and had a liver transplant.
> NUMBER OF PRESCRIPTION DRUGS: 20
> COVERAGE OVERVIEW: Has been unable to get all prescriptions filled
> since his
> son was automatically transferred to a Medicare plan
> Bryan had a liver transplant about 10 years ago that's going south. He
> also
> has renal failure, so he's getting dialysis. And he's a diabetic and has
> high blood pressure. He's on about 20 medications.
> Bryan has been on MassHealth [the state Medicaid program] for a long
> time.
> But when we were put on Medicare in January, Bryan fell through the
> cracks.
> We're in this limbo. He's on Medicare Part A and B, which covers hospital
> care and doctor visits. But why isn't he on Part D? I started calling
> around. The Social Security people said talk to MassHealth. They have no
> clue. They said, ''You should have gotten a letter."
> Nobody's telling me anything about what I'm eligible for.
> For months, we've been getting by on samples from doctors. That was
> supposed
> to go away when we signed up for Part D. What I feared would happen has
> actually happened: He has no drug coverage. Now I'm kind of panicky.
> Literally his life can't go on without these people.
> Today, I tried to figure out which Part D plan to put Bryan on through
> the
> user interface on the Medicare plan-finder website. I'm a high-tech
> entrepreneur, and I really pity people who aren't technically savvy.
> Making the choice came down to how much these drugs will cost my son. He
> gets $400 a month in two checks, and we supplement on top of that. For
> most
> plans, the deductibles alone are going to kill him. When you call the
> enrollment people and say he's on SSI, they say they won't deal with SSI,
> you have to call the SSI folks. Then I call the SSI people, and there's
> nobody there.
> I said to one plan, ''If I pick you guys today, when can I get coverage?"
> Well, the coverage won't start until the next month. I have only 15
> days of
> medication left. I'm looking at the retail cost of these drugs, and we're
> talking a couple-thousand dollars for just 15 days.
> If you're not persistent, I don't know how you can get through this.
> I'm not
> a stupid person, but this really makes me feel stupid.
> © Copyright 2006 Globe Newspaper Company.
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