SACRAMENTO — Even as the state spends millions of dollars on emergency prescription drug coverage for more than 200,000 elderly, poor and disabled Californians, many of their claims are still being denied, healthcare groups said Tuesday.
Patients' advocates and others said they continue to get reports from throughout the state that many enrollees in the federal prescription drug program are being told that their medicines are not covered, or are being charged hundreds of dollars instead of the $1 to $5 co-pay they actually owe.
State officials have been scurrying to backstop the Medicare program. Since Thursday, California has paid for 34,000 prescriptions for people whose claims were rejected after they had been enrolled in the federal program Jan. 1.
Drug plan -- An article in Wednesday's California section about the federal government's new prescription drug plan said John B. Slack needed drugs following a kidney transplant. He had a liver transplant.
Gov. Arnold Schwarzenegger and legislative leaders committed Tuesday to spend up to $150 million in state money to continue such coverage for as long as a month. But even seniors who need life-saving drugs are still falling through the cracks, patient advocates said.
The benefit is intended to offer 43 million Medicare beneficiaries nationwide outpatient drug coverage similar to that which most working people have through their employers. Designed by the Bush administration and Congress, the program uses dozens of private drug plans to deliver benefits at an estimated cost of $700 billion over 10 years.
The plan ran into immediate problems. Computerized databases that pharmacies use for billing had inaccurate information on hundreds of thousands of beneficiaries, primarily vulnerable low-income seniors and disabled people.
"Some of the pharmacies seem to know what they are doing, but others don't," said David Mandel, supervising attorney at the Senior Legal Hotline, a Sacramento nonprofit set up to help low-income seniors enroll in the Medicare program. "Some of them are just exasperated."
California is among many states that are spending millions of dollars to cover those being denied medications. Federal officials have said that they would work to ensure that states that step in are reimbursed by the private insurers involved in the Medicare plan.
Calise Munoz, a regional director for the federal Department of Health and Human Services, said "The money needs to go from the plans back to the state."
Wen Daniels, an Orange County outreach coordinator for California Health Advocates, said several patients told her their pharmacies either had not heard of the emergency system or did not know how to use it.
