Pharmacists and senior citizens are facing the headache of
insurance plan problems since Medicare Part D went into effect Jan.
1.

Betsy Eschrich, pharmacist at Ott & McHenry Pharmacy,
explained that problems with Medicare Part D started with people
who are eligible for both Medicaid and Medicare. She said some
seniors that had their Social Security and Medicaid before thought
they could just stick with that. Unfortunately, Eschrich explained,
these seniors were automatically enrolled in one of the Medicare
Part D plans unless a letter was sent to them. Eschrich said a lot
of people have thrown these letters away not realizing what they
were.

From this point, Eschrich said they have to call one of 54 plans
to find out which plan that person was enrolled.

“There’s probably 38 plans that are new to us,” Tom Drumm,
pharmacist at Tops Market in Bradford, said. “It doesn’t seem to be
concentrated on one or two plans. It’s all over the place. We’re
just getting used to signing these people up on the right plans.
Some aren’t really well-defined.”

Drumm said they have been having a hard time getting through to
insurance agencies.

“They won’t even take the call,” Drumm said. “There’s a
recording that says ‘due to the large volume of calls coming, we
can’t take the call.’ They hang up on you. This has been happening
more frequently now.”

That leaves the pharmacists to take their work home with them to
sort it all out.

“The first week I took the phone numbers home and called at
about 10 p.m. at night and finally got through,” Eschrich said
about calling in one person’s information. “Now we’re about how
many weeks into it, and I was on hold for about a half-hour this
afternoon.”

Roger Feura said Bradford Pharmacy deals pretty much with the
same insurances, but they weren’t geared up to having so many
problems. He said Medicare was always prepared to answer their
phones, but none of the insurance agencies were ready for this due
to the huge number of people switching insurances.

“All of a sudden they hang up on you,” Feura said. “The average
wait time is 161 minutes.”

CVS Pharmacy was so busy on Monday because of Medicare Part D
that they did not have time to answer questions. On Wednesday,
manager Pete Chastain said they deal with the same amount of
insurance agencies but have different programs they’re dealing with
now. He said there’s probably about 108 approved programs with the
new plan along with 20 pharmacy benefit managers.

Jim Zawacki, pharmacist at The Medicine Shop in Bradford, said
they started with 54 plans and added 20. He said they’ve had some
co-payment problems with people on state access programs, but
they’re working with people now on a case by case basis.

Once the pharmacists find out if a person is covered, they have
to find out what drugs are covered in the plan. Eschrich said
they’ve found for those that are covered by a plan there are some
medicines that are not covered for them and they need prior
authorization from their doctors.

“As a corporation, we allow them to have so much medicine to
continue therapy,” Chastain said.

Eschrich said prescriptions can be filled for 30 days after
calling the insurance company first to get it OK’d. With all the
phone calls to make and insurance agencies not answering their
phones, people are having a hard time getting their prescriptions
renewed.

Drumm said the Medicare Part D plan card is restricting some
medications. He pointed out that people that have organ transplants
need special authorization from Medicare for their medicines.

“There’s a lot of red tape,” Drumm said. “We really can’t be
monkeying around with red tape.”

Chastain also said that they have added troubles since many
companies change their insurance coverage the first of the
year.

Eschrich said it’s also bad for people who live in group homes
because some of their letters were sent to their families out of
town.

She pointed out one woman whose mother got her letter. This
woman gets a prescription for seizure medicines, and without her
card, she had a seizure because she was completely out of the
medicine without any way to refill her prescription.

Eschrich also talked about another woman that turned 65 in
November. She said this woman “just disappeared into the hole”
since some of the people that became eligible for Medicare in
November or December are not enrolled in any plan.

“It’s just a headache,” Eschrich said. “It’s so exhausting, just
mentally exhausting. It’s a nightmare. It’s a living hell. We knew
it was coming, but we had no idea how bad it was going to be.”

“They should have eased into it,” Feura said. “They should have
started with one group and then added another. That would have
helped everybody else quite a bit. It’s a lot of frustration for
seniors. Some of them already were covered and didn’t need any
changes. Its original intent was to help those that did not have
any coverage. Overall, it will help out some of the seniors.”

Some of it has gotten better.

Zawacki said they’re currently working with data from the
letters people have received.

“It was tense for a while there,” Zawacki said. “It seems to be
getting better. There’s nothing that we haven’t resolved.”

“I do believe we’re on the back side of this,” Chastain said.
“The people have really been wonderful. They’ve been patient and
everything.”

“In some cases, you do see benefits,” Eschrich said. “There are
people that do have the card, and it’s nice to see that for people
that have been paying out of their pockets for so long.”

Carol Steck, assistant director at the Bradford Senior Activity
Center Inc., said Wednesday that they have held two town meetings
at the senior center because a lot of seniors were having trouble
figuring out the new Medicare Part D Program. She said she’s not
sure if more town meetings are scheduled, but more can be scheduled
if needed.

“We have a volunteer that comes in on Friday mornings from 10 to
1,” Steck said. “If we can’t help them, we have the number for
Medicare, but we try the best that we can. We’ve helped quite a
few. We’re here if they need us.”