MEDICARE PLAN A HEADACHE YET TO BE CURED SENIORS MISLED, CONFUSED, STUDY FINDS.
Byline: Lisa Friedman and Dana Bartholomew Staff Writers
Like millions of seniors across America, Maryanne Golden is still trying to determine whether to opt for an Rx plan under the nation's new Medicare Part D program.
``I'm so irritated,'' said Golden, 71, of Glendale, one of an estimated 100 seniors at a Medicare Forum on Thursday at United Methodist Church in Glendale.
``The finances are really it: You want to be comfortable and secure at this age; you don't want to have to worry about things.''
Even as Golden and thousands of Southern California senior citizens face the dilemma, a new congressional study released Thursday said the plans often offer misleading information and routinely restrict access to drugs they promise to provide.
Seniors expecting to get certain prescription drugs under the nation's new Medicare plan are likely to be told to use a generic version first, or even that they can't receive the dosage recommended by their doctors, according to the report by Democrat Rep. Henry Waxman.
A phone survey also found that representatives of the 42 plans available in Waxman's Los Angeles congressional district often provide conflicting, confusing and sometimes inaccurate information about plan restrictions.
``The whole Medicare prescription drug benefit has been a bitter disappointment,'' said Waxman, the ranking Democrat on the House Government Reform Committee.
``People are trying to figure out what plans cover their drugs. They don't realize that even when they have a plan and the drug is listed, there are barriers.''
But Medicare administrator Mark McClellan on Thursday dismissed Waxman's report as ``misleading in a number of respects,'' arguing that what Waxman called restrictions are in fact tools that private health plans, as well as Medicaid, commonly use.
While prerequisites such as requiring seniors to first use a generic version of their preferred prescription drug need to be applied appropriately, McClellan said, it's ``important to provide effective coverage at a low cost.''
McClellan and Health and Human Services Secretary Mike Leavitt said 1 million elderly and disabled Americans have enrolled in the new drug benefit since last month, bringing the total voluntary enrollees to more than 27 million.
Of those, about 3.2 million are Californians.
Both officials urged seniors that with a May deadline looming, they should avoid the last-minute surge and sign up now. Seniors, however, said they remain confused about what plan to join.
At the Medicare Forum in Glendale - hosted by the Centers for Medicare and Medicaid Services, the Social Security Administration and the Los Angeles County Center for Health Care Rights - seniors wrestled with a confusing world of prescription drug benefits, including ``the doughnut hole'' between $2,250 and $5,100 in drug prescription costs not covered by Medicare.
``I can see the concern, the intimidation, in (some) faces,'' said regional administrator for Medicare Jeff Flick. ``Here's the good news: I encourage people to please get some professional help with this ... there's good quality help available.''
Rep. Adam Schiff criticized the Medicare drug plan for preventing Uncle Sam from negotiating lower Rx prices with drugmakers and for not allowing seniors enough time to evaluate their choices.
``This is a very imperfect plan, but it will help some of you,'' Schiff, D-Pasadena, told the group. ``The reason I opposed it was because the coverage was less than adequate.''
Schiff has proposed legislation to allow a federal health agency to bargain for cheaper Medicare drugs, allow importation of low-cost drugs from Canada and elsewhere, and fix drug choices for one year under HMO Medicare plans.
``Right now, (the plan is) geared to the HMOs to make huge amounts of money at the expense of the patient, because of drug costs and restrictive formulations,'' said Kirk Hiura, a pharmacist from Valencia, who attended the forum.
Many expressed concerns about coverage.
``I'm very confused,'' said Irma Segura, 70, of Glendale, who pays $800 every three months for drugs. ``That's why I brought my son. I want to make the right selection - I don't want to make a mistake.''
In compiling his report, Waxman said his staff focused on finding out whether seniors can actually obtain the drugs that the various plans say they provide.
Investigators found that beneficiaries are in ``a Catch-22,'' unable to learn whether they can get their desired drugs until after they sign up, he said.
Once they do sign up, he said, seniors might discover that despite what they were told, they face at least one of three restrictions: applying for approval, a procedure Waxman said involves ``significant document burdens''; first trying different drugs, such as generic versions of the preferred medicine; or limited dosages regardless of a doctor's prescription.
``Even when you do your homework and study the plans thoroughly, (beneficiaries) are still likely to find out it's a bait-and-switch,'' Waxman said.
Committee staffers, he said, also conducted a telephone survey of each of the 42 plans offered in Waxman's Los Angeles congressional district, which includes part of Woodland Hills.
The survey asked each plan for information about restrictions on five drugs: Advair, an asthma medication; Norvasc, a blood-pressure medication; Aciphex, a heartburn medication; Lexapro, an anti-depressant and anti-anxiety medication; and Ativan, another anti-anxiety medication.
Multiple calls were made to each plan. Among the findings: 38 of the plans restricted access to drugs they promised to provide and two-thirds of the plans were unable to accurately describe what restrictions applied.
According to the report, plan representatives were called back-to-back and on several occasions gave different answers to identical questions.
In many cases, investigators were told they could not receive information about the availability of drugs until they signed on to the plan, Waxman said.
Medicare spokesman Peter Ashkenaz said the agency has been working with the plans to make sure seniors get accurate information.
``If we hear that they're not getting correct information we want to know about it and we can take corrective action,'' he said.
Lisa Friedman, (202) 662-8731
Senior citizens have until May 15 to enroll in a Medicare drug plan without penalty. Some resources for help:
--Center for Health Care Rights, (800) 824-0780
--Insurance company Medicare plan providers
(color) Art Megrdichian, 81, of Glendale speaks with Medicare counselor Robert Diaz on Thursday during the medical insurance seminar at First United Methodist Church in Glendale.
Tina Burch/Staff Photographer
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