Starting Thursday, thousands of elderly and disabled Mainers will have to pay for their own medications – or go without – if they still can’t get what they need from the federal government’s beleaguered drug program.
Maine is pulling its safety net.
The state has been paying for drugs since early January, when the federal government’s new Medicare Part D started and then floundered under a tide of computer glitches and registration problems. At one point, Maine was spending $100,000 a day to pay for drugs that should have been covered under the federal plan.
Federal officials agreed to reimburse Maine for that safety net, but only through Feb. 15. Maine asked for and won extensions, allowing it to pay for prescriptions through March 31.
But when Gov. John Baldacci recently asked for another extension so Maine could keep paying through the end of April, the federal government said no, there wasn’t a need.
“The systems are working. They’re working well,” said Roseanne Pawelec, spokeswoman for this region’s Centers for Medicare and Medicaid Services.
State officials disagree. Many elderly and disabled Mainers are now getting what they need from Medicare Part D, they said, but others are still having trouble.
Last Thursday and Friday, the state helped nearly 1,200 people with 1,755 drugs, according to Jude Walsh, head of prescription drug programs for the Governor’s Office of Health Policy and Finance.
“People’s lives are really at stake,” she said.
To help the very poorest Mainers, the state has set aside about $3.9 million to pay for co-pays and premiums. The federal government has no say in that plan because it involves only state money and Maine will not seek federal reimbursement.
But as of Thursday, the state’s larger, federally reimbursable safety net will be abolished. Mainers can still call the state hot line if they have problems, but they will likely be directed to federal personnel.
Adding to the potential problem: On April 15, anyone enrolled in two Medicare Part D drug plans will be automatically pulled out of one by the federal government. That will affect 20,000 Mainers, and Walsh worries that some will be wrongly kicked out of the one prescription plan they’ve found useful.
While it won’t be as bad as the mass confusion that ruled during the drug program’s early days, “I think it’s a crisis in the making,” Walsh said.
Started on Jan. 1, Medicare Part D was supposed to be an easy way for the country’s elderly and disabled to get low-cost medications, but problems arose within days. Some people weren’t in the computer system, even though they had proof they were enrolled in the new drug program. Some were told they had a plan, but it didn’t cover the medications they needed. Others got a plan and their drugs but were charged up to $100 when they had expected a $1 co-pay.
On Jan. 3, the state held an emergency conference call with pharmacists and told them to fill all prescriptions. The state promised payment, calling it a “safety net.” Other states and cities soon followed.
Maine has not yet been reimbursed for the $5 million it’s spent on drugs, according to Walsh.