MPCA News

Health Centers Help Montana’s Medicare Beneficiaries
with Prescription Drug Coverage Options

Montana’s Community Health Centers (CHCs) are helping Medicare beneficiaries navigate the complexities of the new Medicare prescription drug coverage options.  The new Part D Medicare program began on January 1, 2006 and provides prescription drug coverage to many beneficiaries who did not have prescription drug coverage in the past.   The program has been criticized because of the program’s complexities and problems that Medicaid and low income beneficiaries are experiencing during the transition period. 

In mid-January, CMS released figures showing that just over a third of Montana’s 150,764 Medicare beneficiaries had prescription drug coverage (10,856 in Stand-Alone Prescription Drug Plans, 1,434 in Advantage Drug Plans, 14,750 Dual Eligibles Automatically Enrolled Plans, 21,620 on Medicare Retiree Drug Subsidies and 13,496 on Federal Retiree Programs.)   Montana Community Health Centers serve 5,080 Medicare beneficiaries and have been working diligently with their patients to help them understand and enroll in the new coverage options. 

The Butte-Silver Bow Community Health Center partnered with the local Area Agency on Aging, the Belmont Senior Citizen’s Center, and the Social Security Administration (SSA) to offer patient education and enrollment assistance at several all-day events in Butte, Dillon, and Sheridan.  The CHC patients had the opportunity to meet individually with a SHIP counselor to be assisted with enrollment into a Medicare Prescription Drug Plan, as well as meet with a Social Security representative for an assessment of eligibility for extra assistance. The CHC pharmacist assisted with formulary substitutions to help reduce patients’ monthly expenditures. The Butte CHC pharmacy is enrolled with one Medicare Part D Plan for patients who wish to continue to receive their prescriptions at the pharmacy.  The benefits of staying at the CHC pharmacy include one-to-one patient-pharmacist interaction with education opportunities, therapeutic drug monitoring, and continuity of care.

Cynthia Evans, Case Manager at the Butte-Silver Box Community Health Center, reports their efforts have reached approximately 350 patients with more events planned for the month of March.  Every Thursday during March, seniors will be encouraged to attend an enrollment day at the Belmont Senior Center in Butte.  Events in Dillon and Sheridan are planned for the end of March.  Patient response to the enrollment process has been positive.  An 83 year old gentleman from Butte summed it up best when he said, “I don’t know why I was so reluctant—but I think this will be a really good thing for me!” 

Since November, Deering Community Health Center in Billings has provided more than 250 hours of assistance to Medicare beneficiaries, including telephone calls to clients on Medicare, education for the general public, and one-on-one assistance.  A staff person spends 4-6 hours/week providing follow-up assistance for clients that are experiencing difficulties such as incorrect co-pays being charged, no record of enrollment, inappropriate denial of extra assistance, or have received no plan membership card.  So far, 200 beneficiaries have been assisted with 122 enrolled with many of the remaining waiting for determination on the Extra Assistance from SSA or Medicaid and Medicare.  Most people require two visits—one to present the information to take home to review and a second to actually enroll in a Part D Plan.  Judy Stewart who works with the program at Deering Clinic states, “The overwhelming majority of people seen express their sincere gratitude in having someone available to assist them through the process.” 

Health and Human Services Secretary Mike Leavitt acknowledges that while pharmacies are filling over a million prescriptions a day, “there are, however, a couple of small groups that it’s not working for, and that’s a big problem for them.”  CHCs have been helping beneficiaries through some of the obstacles:

• “Overall, the number one problem we’ve experienced results from the vast amount of choice available to clients.  It’s confusing, overwhelming and difficult to understand.  The fact that some companies have co-pays, some don’t; some have premiums, some don’t; some have the payment gap, some don’t.  It’s too much information for people to be able to synthesize and make any sense of.”
• “Many patients haven’t received letters or cards from the drug companies.  If they have signed up, most don’t remember which company they signed up with.  This makes our pharmacy’s job very difficult as they try to determine what to do for clients.”
• “Many of our clients have presented at the pharmacy, having been approved for extra assistance, only to be charged large co-payments rather than the 1 or 2 dollars they were told to expect.  This problem is getting better, but still prevalent for those people who just recently enrolled.”
• “Another problem we’ve experienced is that the clients who were participating with the Medication Assistance Program are being forced to participate in Part D, even though their costs will dramatically increase.  The pharmaceutical companies who have an indigent program have changed their minds many times as to if those eligible for part D are eligible for their indigent programs.  The bottom line, for most, is that if you’re eligible for Part D, then you’re not eligible for their indigent program.  So patients, who have been paying a $5 co-pay for a 3 month supply of medication, may now be paying $30, $40, or $50 co-pays for the same medication only for one month’s supply.  Justifiably, these folks aren’t pleased!”

Mark McClellan, Administrator of The Center for Medicare and Medicaid (CMS) announced that CMS is working “to address any systemic issues with our enrollment process and infrastructure” as well as working with states, expediting cost sharing approvals, and ensuring beneficiaries have transitional coverage.  The 30 day transitional coverage period has been extended 60 more days to smooth the transition and enable beneficiaries extra time to arrange for alternative treatments if needed.  Montana Department of Public Health and Human Services has stepped in to help pay for “erroneous deductibles and high co-pays” charged to dual eligibles during the transitioning to Medicare drug coverage.  Montana also has a new Big Sky Rx program that provides assistance to beneficiaries with incomes at or below 200% poverty who are not eligible for the federal Medicare Low Income Subsidy (LIS).  Duane Preshinger, Chief of the Medicaid Acute Services Bureau, reports that DPHHS is receiving an average of 50 calls and 60 applications per day.   Of the 2489 applications received by February, 862 have been enrolled and 374 were found not eligible.  The remaining applications were incomplete or awaiting verification of enrollment in a prescription drug plan or the low income subsidy program.    

Montana Primary Care Association 1805 Euclid Avenue Helena, MT 59601 Phone: (406) 442-2750 Fax: (406) 449-2460