Photo by Steve McCasland Pharmacist Steve Wilson, of Shindler’s Pharmacy and Card Shop in Bandon, fills an order for a customer Monday afternoon. Small pharmacies like Shindler’s don’t have the time or staff to verify prescription drug coverage under Medicare, Wilson said.

Gov. Ted Kulongoski has announced a plan to help seniors pay for medications under the new Medicare Part D plans, but only the neediest recipients will qualify for emergency assistance from the state or federal government.

South Coast pharmacies, like others around the country, have been struggling to provide seniors with their medications since Medicare Part D took effect on Jan. 1, and assistance may be a couple weeks late and several yards of red tape too long.

In the meantime, hundreds of local seniors who do not qualify for emergency assistance are paying 100 percent of their prescription costs out-of-pocket - the very situation Medicare Part D was supposed to prevent.

“It's mass confusion,” said Dean Warner, pharmacist for Umpqua Drug Company, a Reedsport pharmacy. “The government set out to cut prescription costs, and the ones who are bearing the brunt of it are the retail pharmacies and the customers who can't get the drugs they need.”

According to local pharmacists, since Jan. 1, customers have been trying to refill medications without insurance cards or proof of benefits. Phone lines and help centers for Medicare Part D plans are clogged with calls from pharmacies all over the country, causing long wait-times that keep pharmacists from verifying coverage.

“The wait times were terrible, and it basically meant we couldn't make those phone calls,” said Steve Wilson, owner and pharmacist of Shindler's Pharmacy in Bandon. “We just can't tie up our phone lines that long, or our personnel.”

Local pharmacies have been forced to decide between providing customers with an emergency supply of medications for free, in the hopes of verifying coverage once phone lines clear or insurance cards arrive, or turning seniors away.

On Friday, the governor approved plans for the state to reimburse pharmacies for 30-day supplies of medications for seniors who are dual-eligible, qualified for both Medicare Part D and Medicaid, if the pharmacist is not able to bill the appropriate insurance carrier or one of the federal benefit plans.

Wilson and other pharmacists started asking seniors to call their own insurance carriers to get the necessary information, an unusual request as pharmacists usually contact insurance companies directly to verify coverage.

To speak with customer service representatives at all of the 46 Medicare Part D plans that serve the South Coast, pharmacists and seniors must spend hours on the phone.

Big retailers absorb cost

Smaller, neighborhood pharmacies have been the hardest hit by the chaos of Medicare Part D.

Large retailers such as Rite Aid, Safeway and Fred Meyer can absorb the cost of providing emergency supplies of medication and wait on reimbursement from the state or Medicare Part D providers. Bigger pharmacies also can spare the personnel for long phone calls to the Part D insurance carriers.

But a neighborhood pharmacy can't afford to provide expensive medications for free, and doesn't have the staff or time to wait for answers from the Part D providers.

According to Warner, the system for contacting, billing, or verifying coverage of his customers' Part D plans, is a disaster.

“In my 40 years as a retail pharmacist this has been the biggest travesty I have ever seen,” Warner said.

Larger retailers seem to have had fewer problems contacting and billing Part D providers.

“We've had very, very few, if any, problems,” said Bridget Flanagan, public affairs director with Safeway. “Things seem to have gone pretty smoothly.”

According to Scott Ellefson, pharmacy manager for the Coos Bay Fred Meyer, his pharmacy has experienced problems with billing and verifying benefits for seniors - but he was optimistic about the state and federal backup plans.

“At the beginning of the year, we experience a lot of insurance plan changes anyway, and Part D only added to that,” Ellefson said. “But it's been pretty hairy the last two weeks.”

Like all the other pharmacies, Fred Meyer had significant trouble contacting Part D carriers to verify coverage to fill prescriptions.

“Sometimes they won't take your call at all, and other times they say the wait time is an hour or 45 minutes,” Ellefson said. “But I think it will improve. I'm confident that one way or another, it will iron out. It always does.”

As of Monday, Ellefson said the pharmacy had started using the Point of Sale system, the federal backup program for dual-eligible seniors, rather than asking the customer to pay.

“It was cumbersome the first time we used it, but it does allow people to get something right away so they won't go without,” Ellefson said. “It's for people who aren't used to having to pay a lot of money out-of-pocket for stuff.”

Backup programs help only neediest

The Point of Sale system, like the backup program provided by the state, provides another option for customers who cannot afford to pay hundreds of dollars for medications.

If a pharmacy can't verify a dual-eligible senior's Part D coverage, and Point of Sale doesn't work, pharmacists can charge emergency supplies of medication to the backup program set up through the Oregon Health Plan.

“We're doing a case-by-case override that the governor's policy put into place,” said Jane-Ellen Weidanz, project manager for the Oregon Department of Human Services Medicare Modernization Act.

According to Weidanz, the governor's plan is only for dual-eligible clients because until Dec. 31, the Oregon Health Plan paid for those seniors' drug costs. The state plan does not provide any assistance to regular Medicare Part D recipients, Weidanz said.

“Unfortunately those individuals will have to pay for their prescriptions however they could before Part D took effect,” she said. “But if they are enrolled in a Medicare Part D program they will be reimbursed by their plans.”

Weidanz said she felt the situation is improving. The Salem office alone had resolved 1,200 cases for seniors not receiving medications in the past two weeks.

“We're starting to see some rays of sunlight, but there are still some huge problems out there. Every day we're getting calls from pharmacies and clients who can't get their medications,” she added.

But for anyone who is not dual-eligible, only time will straighten out Medicare Part D - and until then seniors will have to keep on buying their own medication.