Flaws found in Medicare plan

first_imgWASHINGTON — Southern California senior citizens expecting to get certain prescription drugs under the nation’s new Medicare plan are likely to be told to use a generic version first, or even that they can’t receive the dosage recommended by their doctors, according to a congressional study released today.The report by Rep. Henry Waxman, D-Los Angeles, found that all of the 42 plans available in Waxman’s congressional district routinely restrict access to drugs they promise to provide. A phone survey also found that representatives of the plans often provide conflicting, confusing and sometimes inaccurate information about plan restrictions.“The whole Medicare prescription drug benefit has been a bitter disappointment,” said Waxman, the ranking Democrat on the House Government Reform Committee. Once they do sign up, he said, seniors may discover that despite what they were told, they face at least one of three restrictions: applying for approval, a procedure Waxman said involves “significant document burdens”; first trying different drugs, like generic versions of the preferred medicine; or limited dosages regardless of a doctor’s prescription.“Even when you do your homework and study the plans thoroughly, (beneficiaries) are still likely to find out it’s a bait-and-switch,” Waxman said.Committee staff, he said, also conducted a telephone survey of each of the 42 plans offered in Waxman’s Los Angeles congressional district, which includes part of Woodland Hills.The survey asked each plan for information about restrictions on five drugs: Advair, an asthma medication; Norvasc, a blood-pressure medication; Aciphex, a heartburn medication; Lexapro, an anti-depressant and anti-anxiety medication; and Ativan, another anti-anxiety medication. Multiple calls were made to each plan. Among the findings: 38 of the plans restricted access to drugs they promised to provide and two-thirds of the plans were unable to accurately describe what restrictions applied.According to the report, plan representatives were called back-to-back and on several occasions gave different answers to identical questions.In many cases, investigators were told they could not receive information about the availability of drugs until they signed on to the plan, Waxman said.Medicare spokesman Peter Ashkenaz said the agency has been working with the plans to make sure seniors get acurate information. “If we hear that they’re not getting correct information we want to know about it and we can take corrective action,” he said.Medicare administrator Mark McClellan, speaking in Southern California this week as part of a cross-country tour to promote and explain Medicare Part D, which went into effect Jan. 1, told seniors that the program lowers overall healthcare costs and that needed medicines are adequately covered under the plans.In a speech in New York earlier this month, President Bush noted that the benefit has provided more choices and reduced drug costs for most enrollees, while federal costs for the plan are running 20 percent lower than projected.160Want local news?Sign up for the Localist and stay informed Something went wrong. Please try again.subscribeCongratulations! You’re all set! AD Quality Auto 360p 720p 1080p Top articles1/5READ MORE‘Mame,’ ‘Hello, Dolly!’ composer Jerry Herman dies at 88“People are trying to figure out what plans cover their drugs. They don’t realize that even when they have a plan and the drug is listed, there are barriers.”The report comes on the heels of an independent study released Wednesday by the California Health Care Foundation that found low-income seniors have access to fewer prescription drugs than they did when the state paid for their medications. With a May enrollment deadline looming, many seniors say they’re still trying to decide which plan to use.In compiling his report, Waxman said his staff focused on finding out if seniors can actually obtain the drugs that the various plans say they provide. Investigators found that beneficiaries are in `”a Catch-22,” unable to learn if they can get their desired drugs until after they sign up, he said.last_img