Thursday, Jan. 12, 2006 | 8:48 a.m.
CARSON CITY -- Anticipating the myriad problems plaguing the new federal prescription drug plan for seniors, state officials have set up a program to help people navigate the maze.
Senior Rx, the state-operated system that helps more than 9,000 low-income senior citizens pay for prescription drugs, has set up a one-month transition period for participants to continue to get their prescriptions filled.
Program officials directed participants to sign up for Medicare Part D, which establishes an insurance program to pay for the drugs.
"Any time you start a new program you should expect problems," Laurie Olson, director of Senior Rx, said Monday. Olson said those enrolled in Senior Rx can use their state card to buy drugs if they can't get them through the federal program.
"We planned ahead for this," she said.
But many seniors across the nation and in Nevada who are not in the Senior Rx plan are experiencing problems getting their prescriptions since the new federal program started Jan. 1.
To temporarily fill the gap, the state Division of Mental Health and Developmental Disabilities is giving out sample prescription drugs to those patients who can't get their drugs through the federal program.
"A lot of consumers are having a hard time with this," said Carlos Brandenburg, director of the division.
Keith Macdonald, a pharmacist and former executive director of the state Pharmacy Board, said some stores "are giving out drugs for free until they get settled up."
He said the pharmacies are getting enough information to make a claim later to the insurance companies.
Charles Duarte, administrator of the state Division of Health Care, Financing and Policy, said some of the 17,500 elderly and disabled in the state-operated Medicaid program also are having problems.
"I talked to five pharmacists and there are significant problems," Duarte said. "They are trying to help the people the best they can. Private providers are giving away samples."
Duarte said a decision would have to be made by the end of the week on whether the state should step in and help the Medicaid recipients until the federal program smooths out.
"It would cost $6 million to handle the prescription drugs of the 17,500" for a month, Duarte said.
Under the federal program, those seniors and disabled people signed up with an insurance company to cover part of the cost of drugs. Some people have a letter saying they are eligible but did not receive a card. Pharmacies must call to verify the person qualifies.
The phone lines have been jammed both to Medicare and to the insurance companies.
Macdonald said pharmacists have been put on hold on the telephone for "extensive periods of time, and then they are hung up."
"The phones are cut off. It's frustrating to get the right information to get a claim for payment," Macdonald said.
"There is no reimbursement for sitting on the phone for 45 minutes," he said, adding that a flat fee per drug is paid and there is "lost employee time."
Allison Vincent of the Medicare Pharmacy in Carson City said an extra pharmacist had to be hired to handle the increased business. She said calling the insurance companies to verify a person is covered is a long process.
Vincent said Monday some insurance companies have recordings saying their phone lines are jammed, and advising people to call back later. One company, she said, suggested calling after 6 p.m. or on Saturday.
"We're urging the federal government to assure payment if the people had trouble with identification," Duarte said. "But the feds are not amenable."
Brandenburg said his staff is working with mentally ill patients to fill out the applications. He said the division wants to make sure medications are given to those who need them so there will not be a relapse.
The Legislative Interim Finance Committee agreed that the state would pay $23 of the monthly premium of those who are enrolled in the Senior Rx program when they are converted to the Medicare program.
Cy Ryan can be reached at (775) 687-5032 or at [email protected].
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