In Texas Town, New Drug Plan Baffles Patient and Provider

[cal04]

In Texas Town, New Drug Plan Baffles Patient and Provider Alike

In Washington, Bush administration officials say Medicare's new prescription drug program is humming along smoothly, filling more than three million prescriptions a day and cutting costs by an average of 50 percent for each beneficiary. But here in the Rio Grande Valley, the picture is different. Many patients say they have difficulty getting the drugs they need.

Pharmacists, swamped with questions and complaints from beneficiaries, have run into many practical problems as they try to navigate a complex program administered by dozens of prescription drug plans, each with its own policies and procedures. Doctors and pharmacists are struggling to figure out which drugs are covered by which plans. "Intellectually, the program is a good idea," said Dr. E. Linda Villarreal, a former president of the Hidalgo-Starr County Medical Society.

"But there's been total chaos and confusion among most of my patients, who do not understand the system and how to work it." While acknowledging that there were problems at the beginning of the program, the administration has said in recent weeks that those issues have abated. But for Republican and Democratic lawmakers alike, concerns surrounding the benefit have special resonance heading into the midterm elections in November. Jose M. Flores, a Medicare beneficiary who lives outside McAllen, used the new drug benefit four times from January to April to purchase Byetta, an injectable medicine for diabetes.

Each time he paid $40. So when he went to the pharmacy on May 25, he was dismayed to be told that he owed $167.56 for the next month's supply. Mr. Flores had reached the notorious gap in Medicare's drug coverage. He had to pay the full price of Byetta. His Medicare drug plan paid nothing. "It's almost useless," said Mr. Flores, a 66-year-old school bus mechanic who was interviewed at his home in La Joya, Tex. "I'm paying the premium, but not getting protection."

more
http://www.nytimes.com/2006/06/11/us/11medicare.html?hp&ex=1149998400&en=b85d30a3c1196951&ei=5094&partner=homepage