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The drugs they need

January 11, 2006

NO ONE REALLY EXPECTED the new Medicare prescription drug program to be "fail safe" (although federal officials actually used that phrase). But early signs, in California and other states, are that the days-old program may be failing those who need it most.

A worrisome number of seniors are having a difficult time getting vital medications under the program, which began Jan. 1. Seniors who should be covered are being forced to pay for expensive drugs out of pocket. Pharmacists are having trouble finding out which plan people are enrolled in, forcing some to leave pharmacies empty-handed. The most desperate are showing up at emergency-room doors hoping to get the medication they were promised. Meanwhile, waits on help lines set up by the government and private insurers have stretched into hours.

Mark McClellan, head of the agency that oversees the program, points out that it is filling as many as a million prescriptions a day. But it appears low-income seniors and disabled people known as "dual eligibles" -- the 6 million Americans covered under both Medicare and Medicaid, the federal program for the poor -- are disproportionately having problems. Unlike everyone else -- who have until spring to sign up before getting penalized -- those on Medicaid had to switch to the new drug plan on the first day.

The problem: Federal officials didn't process all of their applications on time, so when an untold number of the poorest and often sickest seniors went to fill their medications in recent days, they weren't in the computer. At least four states -- Maine, New Hampshire, North Dakota and Vermont -- have already decided to spend millions to care for those who are slipping through the cracks, even though it is unclear whether the federal government will pay them back. As of Tuesday, California officials said they were considering doing the same. The tab could exceed hundreds of millions of dollars.

What is most frustrating is that there was ample warning about potential problems, and people on both ends of the political spectrum worried that starting the plan now was overly ambitious. But the administration insisted it begin in an election year.

There will be plenty of time for finger-pointing down the road. What's important now is to solve the mess at hand. California should follow other states and fund prescriptions for those who are going without, even for a few days, and cross its fingers that the feds pay the money back. Beyond that, it is hard to see how the federal government could choose to do anything but open its wallet to fix this problem. One idea is for the government to sign up a private insurer to temporarily cover any eligible senior who is having a hard time getting medications -- a solution that would take only a matter of days to implement. And in this case, speed is both politically expedient and practically necessary.

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