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Medicare Part D – the enrollment debacle

The news about the debacle that is the Medicare Part D roll-out has been well-publicized, along with the details that the individuals most heavily impacted are the 6 million dual-eligibles; those folks covered under both Medicaid and Medicare. They should have been automatically enrolled as of 1/1/06, but many states are experiencing big problems.
The key issue appears to be pharmacies are not able to access eligibility information in government databases through the normal EDI links, requiring the pharmacists to call Medicare where they spend hours on hold. Meanwhile, patients aren’t getting their drugs.
If this was just a case of a few scripts for Propecia or Viagra going astray, no big deal. But we’re talking beta blockers, insulin, cancer drugs, pain meds, scripts for Parkinson’s and the like. Life and death stuff.
Many states have provided emergency funding to enable these people to get their scripts. And this will get ironed out at some point.
The larger issue is the canary-in-the-mine nature of the problem. Many health care experts, politicians, and even some politicians who claim to be experts are putting a lot of faith in technology to root out fraud and abuse, enable better delivery of medical care, enhance evidence-based medicine and streamline the delivery of electronic health records. The Bush Administration in particular is highlighting technology as a big part of the “solution” to the health care crisis.
While there is no doubt technology can help address some of the problems in health care, history is also replete with examples of how solutions made problems worse.
Here’s hoping Sec. Leavitt and his colleagues at Health and Human Services get their act together before this gets really ugly.
What does this mean for you?
If you are a pharmacist, you don’t have time to read blogs unless you do so while on hold.

9 thoughts on “Medicare Part D – the enrollment debacle”

  1. A bigger problem, which will surface AFTER the computer glitches are corrected, is the perpetuation of the myth that auto-enrollment of the 6.4 million dual eligibles was a plan that would “ensure that people get their medications.”
    In fact, the auto-enrollment was totally random, with no matching of a person’s prescription needs with the plan in which they were enrolled. But, with all the assurances, many people did not understand this, and are just beginning to realize, once the computer works, that they still can’t get their medications because they’re not covered.
    And people who did realize this and made a deliberate choice after November 15th are finding that they were still auto-enrolled in the random plan.
    Auto-enrollment was actually a disservice, far more PR than realistically helpful, and we will see these problems surfacing over the next few months. It will be quite a while before this settles down. It should be fine just in time for the next auto-enrollment on May 31st, and we can start all over again.

  2. Typical Bush “Big Promises” NO Follow Thru.
    As Seniors wait for the medication, We all have to Wait for our medication. As if the Pharmacy experience was not frustrating enough to begin with.
    My father can no longer go where it is convenentto obtain his medication. He must go where his plan dictates he go. In the golden years MUST we make it more difficult.
    Bush should have tested this plan on Mom and Dad, before he pushed it on the Public.

  3. While this latest fiasco must be owned by Bush who pushed the buttons to make it happen, the entire thing should be a flashing neon sign to anyone considering that the US Government should be in the healthcare business!
    The result of healthcare, courtesy of the government, would be both paralysis in terms of actual care, and expenses beyond belief!
    Keep government OUT of healthcare…it is bad enough as it is without the idiocy of bureaucracy!

  4. Well you now know why fed employees have opted out of plan d, they knew it stunk. Not good enough for them but good enough for us. How many other states have not used it for their employees. Why are my taxes always paying for a better health plan than I have. You can bet that if the feds were forced into this plan it would be better and cheaper

  5. Exactly right, PissedTpr. If it is THAT inconvenient, don’t enroll in Part D. If the expenses were really that bad, and you felt you HAD to enroll, you have got to realize that there’s a tradeoff. There always is. Nothing is free. Nothing is simple. And people who holler “gimme” will get something, just maybe not what they think or what they hope. Who in their right mind would enroll and think it would be EASY??

  6. The problems of Medicare Part D are and will be the same as the other parts. It’s just that traditionally those other parts have been shouldered much more often by doctor’s offices. The major benefit of this Part D addition is that it rights a historic imbalance that favored expensive surgery over cheap drugs. Once the waves over that shift calm down, we can get to the real job of taking all of Medicare and reforming it so that it does a better job of taking care of seniors. In the end, I suspect that’s going to be via a private care route because the State sucks at delivering medicine as much as it does at delivering food.
    Without rebalancing care so that coverage vaguely matched good medical practice, any further reform were always going to be DOA. President Bush’s contribution (as most of his government reform contributions are) is that now we can see much more clearly how bad our current system is. This will make creating a future Medicare reform coalition much more likely.

  7. As I researched programs (lots of seniors didn’t get as lucky)I could see that the plans were not ready for the rollout and other communication with Medicare and the drug plans was slow to non-existent. Saw the problem at the pharmacy yesterday, but it is a one-time problem. The greater problem is that I don’t need it now but am heavily penalized unless I sign up. I don’t see how including me helps the system as I am profiting as much ($100 down to $40/month versus $27 premium) as any poor soul who REALLY needs help. It should be means tested and open to me when I really need it. Bad economics.

  8. After all we’ve witnessed from the Bush Administration, you’re going to look at Medicare Part D as the sign that government and healthcare can’t work together? So… I guess Intelligence should be privatized, and disaster relief, and every other government function that used to work pretty well and is suddenly an abject failure now that Bush is President. Just because the Bush Administration can’t govern its way out of a paper bag doesn’t mean Government can’t do anything right.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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