Civil Law

For the past five days, Bill Keely of DeLand has been trying to get to the bottom of why his drugs -- once free through the state's insurance plan for the poor -- are now sitting at the drugstore with a $400 price tag.

Keely, who's 90 percent blind, uses a wheelchair and collects $767 a month in disability benefits, is in the middle of phone conversations with his drug plan company, Social Security, the Department of Children & Families and Medicare.

"No one will talk to each other," said Keely, who, by his calculations should be paying only $18 a month for the prescriptions. "They are still charging me the full co-pay."

His story is one of many problems that have emerged in the first few days of the federal prescription benefit that's supposed to make drugs more affordable for some 43 million Medicare beneficiaries. The problems have plagued particularly those with low incomes, but it could be worse, according to some.

"It's not going as horribly as I thought it was going to go," said Dr. Stephen Young, medical director for Act Corp. in Ormond Beach, which serves the area's mentally disabled. "There are people showing up and not getting their medicines, but there are a lot of people working it out and trying to fix it."

Among the problems that have cropped up for low-income Medicare beneficiaries:

· Some Floridians are going to the drugstore and finding that drugs that the state had been paying for are now available only at full price. These include benzodiazepines that are commonly taken by people who are on strong anti-psychotic drugs, and prescription strength vitamin/mineral supplements for dialysis patients.

· People who qualify for federal help paying for their deductible and should be paying co-payments ranging from $1 to $5 for each prescription are being charged the full deductible, premium and a percentage of their drug costs.

· Those who were on Medicaid and eligible for Medicare have been automatically enrolled in a Medicare prescription drug plan, which may not carry the drugs the patient needs. All the plans were to cover standing prescriptions for the first 30 days and that's not happening, health providers say.

These problems are landing squarely at pharmacies' doors where pharmacists are faced with either denying drugs to customers who can't pay or covering the cost themselves.

"The biggest problem is that when you have a problem, it's impossible to get help," said Randy Margrave, a pharmacist at Holly Hill Pharmacy, who has spent up to 40 minutes on a call to a drug-plan company trying to find answers. He's given customers enough pills to hold them a few days, hoping that things will get worked out. "It's kind of frustrating when you can't get answers right away."

Peter Ashkenaz, a Medicare spokesman in Washington, D.C., said that a special hot line has been set up to answer pharmacists' concerns and capacity on the line has been increased in the last few days. He said that problems are cropping up particularly for people who were automatically enrolled in a plan and then have chosen another plan that carries the drugs they need.

"What we believe is that there are some slow points," he said.

At Dixie Lodge Assisted Living Facility in DeLand, 19 patients have been shifted to a prescription plan that doesn't cover the medicine they need to ease the side effects of anti-psychotic drugs, officials there said.

"You will see increased signs of agitation, violence -- people acting out in a more aggressive, inappropriate kind of manner," said Walker Richardson, administrator of the facility. "You're taking away medications that have controlled side effects for years."

A few days into the benefit, Richardson said he was running from one crisis to another.

"We're still trying to get the forms" that would allow patients to receive drugs not on the plans' formulary, or list of covered drugs, Richardson said. "People are not showing up on the computer (as beneficiaries). You solve one problem and find out there are two more."

Miriam Harmatz, a Florida Legal Services staff attorney in Miami, said that the Legislature eliminated a program for the aged and disabled, transferring 77,000 Floridians to the Medicare drug benefit.

"We've cut our program to the bare bones of what's required by the federal government," she said.

Whether it works will be apparent from what shows up in area hospitals' emergency rooms, said Dixie Lodge's Richardson.

anne.geggis@news-jrnl.com