WSFA 12 News Montgomery, AL |Suggestion: If You Signed Up for Medicare Part D, Wait

Suggestion: If You Signed Up for Medicare Part D, Wait

You've waded through the 43 or so choices in Alabama for the new Medicare prescription drug plan and made your choice on the Medicare.gov Web site prior to Dec. 31 so you can get your new drug coverage starting the first of the year. You walk into your local pharmacy and zing, you have to pay full price for your prescriptions! What's going on?

The new Medicare prescription drug benefit took effect on Jan. 1. However, nationwide reports are of many glitches in a system not quite ready to deal with all the demand.

Dianne Pickett, a pharmacist at Montgomery's independent Richardson's Pharmacy, says the best thing for people to do who don't need drugs immediately is to "wait, and be patient. If you have leeway and don't need prescriptions immediately, you're better off waiting," says Pickett.'

Picket says the new system is "overwhelmed, under prepared.... It may take two weeks to get things cleared up." She says they knew there would be problems with the new program. As with most new government programs, it takes a while for problems to get ironed out.

"There are so many different plans and they don't all require the same information to sign up," advises Pickett.

Problems can enter the system in many different areas.

For instance, once the drug plan company gets your sign up information, the company puts you in their system and then has to verify your eligibility with Medicare. The company also finds out from Medicare if you are eligible for what is called "extra help" in paying part of your premiums and deductibles.

A problem can come in when the information from the company doesn't match the Medicare database exactly. Some items are case sensitive and consumers can be unverified due to typos or case sensitivity or other information not matching up with Medicare.

Also, Medicare is experiencing backlog issues due to a lot of people signing up at the end of the year.

Richardson's has had only a few customers come in and try the new plan because the pharmacy was not open on Sunday or Monday, the first two days of the plan. Like many pharmacies around the country, Richardson's has had a few glitches, but expects the problems to soon be resolved.

One thing not well planned in advance, according to some reports from other areas of the country, was the coordination of the different computer systems used by different pharmacies across the United States. Some pharmacies have the latest technology, while others are running systems that have always performed well, but now don't interact well with the new systems and software.

Another problem is the information on the Medicare Web site and the site of some company drug plans list pharmacies as taking a particular drug plan, when in reality the pharmacy does not take that particular plan. Some consumers walk into their favorite pharmacy only to find the pharmacy they have been using for years does not participate in a particular plan.

Richardson's ran into this issue with the AARP Medicare Rx plan which listed Richardson's as a participant in its plan. The information was also on Medicare.gov. The problem, Richardson's is not a participant of the AARP plan.

Richardson's faxed information to the appropriate entities when the problem was discovered; however, there appears to be a significant lag time in incorrect information getting corrected on the Web sites.

Consumers who were getting their drugs paid for by Medicaid may also run into problems if they did not sign up by Dec. 31. Medicare is automatically enrolling these consumers into a drug plan. The problem: The drug plan may not cover all your medications. If you find yourself in this situation, you may change plans without penalty. The ability to change plans only applies to people who were getting their drugs paid for by Medicaid prior to 2006.

So what should you do before you make a trip to the pharmacy to get your medications?

Make sure your pharmacy is accepting your new drug plan. You should have checked this prior to enrollment, but check it now if you have not.

If you have received a letter from the drug plan company, but have not yet gotten your prescription drug card, take the letter with you to the pharmacy.

Pickett says if you have not gotten a letter or a card from your new drug plan, you need to call your new drug plan and find out what your status is before you make a trip to the pharmacy. You may think you have coverage but you may have been rejected by the system for some reason, the drug plan company may be able to help you work those issues out.

When you call your drug plan, make sure to get your member number. Your member number is the main key your pharmacist needs to be able to help you.

Also, if you signed up on the Internet for the coverage, make sure you have your confirmation number with you when you call your new drug plan. This may help them locate your information.

Other things to remember

Information changes constantly in the new system. What was good information last week may not be good this week. Formularies are still changing.

Pickett says the new drug plan is not for everyone. "If you don't take a lot of medicines, you may be better off not joining the plan...Remember it is voluntary." Nonetheless, remember that if you join after May 15, 2006, you will be penalized for joining late.

Also, if you have prescription drug coverage through your employer, your present drug plan may provide better coverage than the new plan.

Some people have found that their drug costs are actually higher under the new plan.

Another thing that is getting consumers is some plans are encouraging seniors to leave Medicare and join an HMO type system. This is not necessary to get prescription drug coverage.

Be sure you are signing up just for prescription drug coverage if you want to stay in the original Medicare plan.