Hoeven offers to ease chaos

North Dakota pharmacists plagued with problems following the launch of the federal prescription drug benefit program will find help from the state, officials said Friday.

Gov. John Hoeven authorized up to $2 million to be used for pharmacies struggling to receive federal reimbursements during the early weeks of the new Medicare program.

The announcement comes after a week of chaos and confusion in pharmacies created by what some are calling poor planning by the federal government.

Computer issues, backed-up phone lines and customers without enrollment cards have left pharmacists scrambling to determine what benefit plans customers have.

But when they try to find out by calling the customer's provider, pharmacists get stuck on hold because the phone lines are flooded with similar calls.

Some pharmacists, like Randy Habeck in Hillsboro, N.D., decided to rely on charge accounts and give customers their medication without payment until their insurance plan is verified.

But state officials are worried that some residents won't receive their medication or be able to afford it without their cards or verification information.

"We want to make sure that all these folks who are Medicaid eligible ... that they're not turned down for their scrips," Hoeven said.

The state administered prescription drug coverage for Medicaid beneficiaries until the federal program took effect on Jan. 1.

State officials are extending the North Dakota's program until Jan. 23 to cover the federal obligation until the government works out its glitches.

The state will then be reimbursed by the federal government, Hoeven said. Pharmacists should notify the state if there are still problems after Jan. 23.

Habeck, chief pharmacist at Hillsboro Drug and Gift, called the past week a disaster and had hoped the state Medicaid system would offer help.

At least half of his customers didn't have their card numbers, particularly those covered by Medicaid.

Trying to track down the information during the day has been nearly impossible with the busy phone lines, he said. He's been returning to work to make calls at night.

For the information he can't track down, Habeck made a "good faith" decision to write up IOUs for his customers, rather than deny their prescription medication.

"You don't know what to bill. Basically, what we've been doing is getting the patient the prescription until we hear back on what their insurance is," Habeck said.

The prescription drug benefit is open to anyone on Medicare, the federal health insurance program for those 65 and over.

People must enroll in a plan offered by a private insurer that contracts with the federal government.

Those with dual eligibility under Medicaid and Medicare were automatically enrolled in a prescription drug benefit plan by the federal government on Jan. 1 if they didn't select their own plan.

In most states, beneficiaries have at least 40 plans from which to select.

The insurer then issues a card beneficiaries take to the pharmacy. The pharmacist scans the card to determine the type of coverage the customer has. That determines out-of-pocket costs.

About 95 percent of the state's nursing home residents were enrolled in prescription drug plans that didn't fit them, said Shelly Peterson, president of the state's Long Term Care Association.

About 3,500 of the 10,400 North Dakotans with dual eligibility under Medicare and Medicaid are in nursing homes.

However, even with paperwork completed on time to enroll them in the correct plans, government backup has also left nursing home residents without program cards.

The average nursing home resident is on nine medications, making access to medicine critical for their well-being, Peterson said.

Medicare-eligible residents who don't qualify for Medicaid also had problems with the new prescription drug program, said North Dakota Insurance Commissioner Jim Poolman.

Inaccuracies in plan materials caused some residents to realize they need to sign up for a different plan.

Delays in getting enrollment cards and changes in co-pays are other issues, he said.

His office's support team has received more than 3,000 phone calls in the past five weeks from people needing help figuring out the new program.

About 105,000 North Dakota residents are eligible for Medicare. Poolman did not know how many had signed up for the prescription drug benefit program.

Despite all of the program's initial problems, Poolman still encourages people eligible for the prescription drug benefit program to join.

"We don't want seniors to lose out on potential savings from the program," Poolman said. "We're going to do our best to help those folks."

The Associated Press contributed to this story. Readers can reach Forum reporter Teri Finneman at (701) 241-5560