Legislature(2005 - 2006)CAPITOL 106
02/02/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Overview(s) || Department of Health and Social Services on Medicare Part D | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
February 2, 2006
3:04 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Vic Kohring
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
Representative Tom Anderson
Representative Carl Gatto
COMMITTEE CALENDAR
OVERVIEW(S): DEPARTMENT OF HEALTH AND SOCIAL SERVICES ON
MEDICARE PART D
- HEARD
PREVIOUS COMMITTEE ACTION
No action to record
WITNESS REGISTER
ESSIEN UKOIDEMABIA, Director
State Health Insurance Assistance Program (SHIP)
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Presented the overview on Medicare Part D.
JON SHERWOOD, Medical Assistant Administrator for Medicaid
Office of Program Review
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions regarding Medicare Part
D.
BILL ALTLAND, Owner
Whale Tail Pharmacy;
Member, Pharmacy Board
Craig, Alaska
POSITION STATEMENT: Testified as a pharmacist regarding
Medicare Part D.
DIRK WHITE, Owner
Harry Race Pharmacy & Photo
Sitka, Alaska
POSITION STATEMENT: Testified as a pharmacist regarding
Medicare Part D.
DON ROBERTS
Kodiak, Alaska
POSITION STATEMENT: Testified as a disability recipient
eligible for Medicare Part D.
BARRY CHRISTENSEN, Pharmacist
Ketchikan, Alaska
POSITION STATEMENT: Testified as a pharmacist regarding
Medicare Part D.
JENNIFER ADAMS, Representative
Anchorage Community Mental Health Services (ACMHS);
Program Coordinator, Medicare Plan D
Anchorage, Alaska
POSITION STATEMENT: Testified regarding administration of
Medicare Part D.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:04:17 PM.
Representatives Kohring, Seaton, Cissna, Gardner, and Wilson
were present at the call to order.
^OVERVIEW(S)
^DEPARTMENT OF HEALTH AND SOCIAL SERVICES ON MEDICARE PART D
3:04:35 PM
CHAIR WILSON announced that the only order of business would be
a presentation by the Department of Health and Social Services
(DHSS) on the implementation of Medicare Part D.
3:05:55 PM
ESSIEN UKOIDEMABIA, Director, State Health Insurance Assistance
Program (SHIP), Division of Senior and Disabilities Services,
Department of Health and Social Services (DHSS), stated that the
federal government funds a SHIP director in every state through
the Centers for Medicare Services (CMS) and Medicaid in
conjunction with the U.S. Administration on Aging and the Senior
Medicare Patrol. The SHIP office distributes information on
Medicare and other federal, state, and private health care plans
that interface with Medicare programs. She explained the
elevated demand for information and assistance that began in
2005 due to the implementation of the Medicare prescription drug
plan, Medicare Part D. This revised program provides drug
assistance benefits for those individuals covered by both
Medicaid and Medicare through pharmacy benefit plan companies.
She described the volunteer program that SHIP established in
Alaska to handle the workload. The focus, she said, has been to
train volunteers who then train more volunteers to provide one
on one assistance for the elderly and disabled statewide.
Responding to Chair Wilson, she said that of the initial 100
volunteers, 51 provide the elderly and disabled with assistance
to enroll in Medicare Part D, and stressed that all of the
information and enrollment criteria is easily accessed via the
internet at www.seniorcarealaska.gov. Further, she clarified
that her position with the state is funded through two federal
grants.
3:09:05 PM
MS. UKOIDEMABIA described the three concurrent programs which
SHIP administers: information dissemination and enrollment for
new Medicare Part D enrollees, or re-enrollment for existing
clients; Social Security Extra Help program for low income
individuals who need assistance to cover the Medicare "doughnut
hole;" and the Alaskan SeniorCare (ASC) prescription drug plan
that serves as a wrap around for the Medicare program. She
fully described the parameters for enrollment in each of these
programs and delineated the various eligibility requirements
based on age, income, and assets.
3:10:42 PM
REPRESENTATIVE CISSNA described the possibility that some
eligible individuals may require one on one assistance to help
them with this change, and asked how SHIP is instituting this
outreach aspect.
MS. UKOIDEMABIA stated that the department is aware of such
situations, thus SHIP volunteers make in-home welfare checks to
assist residents. She assured the committee that SHIP's
outreach program is extensive, and described the contact
procedures being implemented, particularly in the villages.
3:16:06 PM
MS. UKOIDEMABIA explained that CMS finances the three SHIP
programs which are in turn supported by 11 participating
pharmacy benefit plan companies which provide 28 plan options
for Alaskans. She described issues that have arisen during this
time of change, particularly with participating pharmacists who
have reported experiencing an inefficiency in accessing
client/program details, with resultant delays to the consumer.
3:17:23 PM
CHAIR WILSON asked whether every Medicare client was defaulted
to an option with a new benefit plan company assigned to cover
their pharmaceutical needs, when Medicare Part D was enacted,
and furthermore, if each client must now access this default
information to ascertain whether they are appropriately enrolled
and make any necessary changes.
3:18:07 PM
MS. UKOIDEMABIA clarified that it was only the dual eligible
Medicaid and Medicare enrollees, who were randomly defaulted to
a new plan in January 2006, and who now have one year to select
from the various plans and re-enroll in the one appropriate for
them. In response to Chair Wilson, she explained how SHIP
volunteers help the enrollees to compare and choose a cost
effective prescription drug plan. She stressed that this help
is provided to the enrollees for any of the three described
programs, utilizing translators when necessary.
3:20:50 PM
REPRESENTATIVE SEATON asked how benefit plan assignments are
being rectified for the dual eligible clients who reside in an
assisted living facility which doesn't recognize the default
plan, effectively leaving the resident without prescription drug
coverage. Further, he asked whether there is a 30 day delay in
benefit start-up from when the client enrolls in the appropriate
plan.
JON SHERWOOD, Medical Assistant Administrator for Medicaid,
Office of Program Review, Office of the Commissioner, Department
of Health and Social Services (DHSS), explained that nursing
care and assisted living care facilities operate under different
rules; however, clients in both facilities have been effected by
being randomly assigned to a new benefit plan company. He
explained that a client may be assigned to a plan that hasn't
contracted with their facilities participating pharmacy. In a
nursing home, a plan is obligated to provide drugs, via
authorizing an "out of network exception" purchase, through the
long-term facilities regular pharmacy. In assisted living
facilities, the requirements provide residents the option to
continue to receive prescription drugs via their previous
provider while they establish enrollment with a new benefit
plan. Once a client's appropriate enrollment is established or
changed, coverage takes affect at the beginning of the following
month, which can create a transitional lapse requiring coverage
through the "out of network" proviso. In further response, he
clarified that if a client is enrolled in "plan A" and is
changing to "plan B", "plan A" is expected to provide
prescription drugs until such time as "plan B" assumes the
responsibility, thus creating a seamless change-over.
CHAIR WILSON described a situation in which a pharmacist was
denied a contract with a particular benefit plan company making
it impossible to dispense prescription drugs to the clients who
were assigned or had chosen that particular benefit plan
company. She asked how this type of situation is being
addressed.
MR. SHERWOOD explained that the state has been providing
prescription drugs for the dual eligible clients, but as of
January 1, 2006, this became the obligation of the private
benefit plan companies through Medicare Part D. He described
the four major steps taken by the department to implement this
change. During the last week of December 2005, 30 day refills
were authorized for all non-controlled drugs for Medicaid
recipients, to provide clients a supply buffer for the first
transitional month. Additionally, procedures were sent out to
the dual recipient clients to present to their pharmacists which
ensured that reimbursement would be forthcoming for the
pharmaceutical services rendered. Included in the information
was a hot line number for prescription authorization via
Medicaid's fiscal agent First Health. In response to Chair
Wilson, he explained that authorization is accomplished by
entering a pre-authorization code into the system, which is then
used by the pharmacist for billing purposes to provide immediate
claim processing and weekly reimbursement.
3:29:21 PM
CHAIR WILSON reported that pharmacists are reporting difficulty
in getting through on the toll free telephone number, to the
detriment of the customers and the business. She asked where
the toll free telephone numbers originate, and whether this
heretofore-cumbersome situation has been improved.
MR. SHERWOOD stated that the toll free lines are sometimes
answered in Alaska but primarily route to Virginia, and that to
his knowledge the system is improving. He explained where the
bottleneck occurs, and said that CMS has issued instructions to
all of the benefit plan companies to provide additional
telephone lines, including "specialized" lines. In further
response, he stated that he is not sure how many total lines are
available in Alaska or nation wide.
3:31:11 PM
REPRESENTATIVE CISSNA asked whether it is First Health who
covers these lines, and whether First Health is not also
responsible for fielding a myriad of other authorization calls.
MR. SHERWOOD confirmed that First Health does field calls for
other agencies, but pointed out that the pharmacies were
dedicated a line for Medicaid authorization purposes.
3:32:00 PM
REPRESENTATIVE GARDNER suggested that it would be illuminating
to have someone at this hearing call one of the help lines to
check the accessibility and response time.
3:32:27 PM
REPRESENTATIVE SEATON noted a significant difference in the
program costs, and asked whether there is reimbursable subsidy
limit for the dual eligible clients.
3:33:23 PM
MR. SHERWOOD explained that there is a limit to the amount of
the premium that the federal government subsidies based on a
formula called the "Alaska Benchmark," currently rated at
$34.66. Any dual eligible client who was automatically assigned
to a plan was assigned to one of the seven Alaskan plans priced
at or below this benchmark amount. He pointed out that
enrollees may elect to sign up for a plan that requires a higher
premium and pay the difference out of pocket. Asked to explain
the advantages of the higher premium plans, he responded that
the primary difference is the price reduction on drugs not
otherwise covered; commonly referred to as "the doughnut hole."
Furthermore, he assured that the seven available Alaskan plans
all cover 75 to 95 percent of the 100 drugs most commonly
prescribed to Medicare clients. Additionally, each plan is
required to allow beneficiaries the opportunity to apply for
preferential treatment if they have a medical necessity to use a
drug not otherwise covered. He stated that this formulary
exception provision also allows for an appeals process.
3:36:08 PM
CHAIR WILSON asked how easy it is to apply for the formulary
exception/appeal, whether it can be managed over the phone, and
who helps the elderly and disabled clients through the process.
MR. SHERWOOD responded that usually the client's doctor or
prescribing physician, and sometimes the pharmacist provides
assistance. He explained that CMS is targeting the doctors and
pharmacists to receive instructions on how to obtain a formulary
exception, as it usually requires some medical justification or
explanation.
CHAIR WILSON pointed out that this could be a significant burden
for the doctors or pharmacists. She asked Mr. Sherwood if he
could report on how the pharmacists are handling this imposed
obligation, whether the department has been contacted by any
pharmacists, and how DHSS has responded to their needs.
3:37:51 PM
MR. SHERWOOD stated, "They have certainly let us know they're
having problems, and they are having to work long and hard to
work through the problems with plans, and the backup plan, and
CMS." He described the difficulties, confusion, and delays
being experienced by the pharmacists as they attempt to fill
Medicare prescriptions through the newly defaulted/assigned
plans, ascertaining which plan applies, establishing whether
it's the appropriate plan for the client, and dealing with the
miscommunications from Medicare regarding a client's co-pay
applicability. The department has implemented contingency
procedures to enable clients to receive their prescription drugs
via a pre-authorization code. Theoretically, the pharmacist
accesses the code through the First Health help desk telephone
number, and the state provides follow-up to bill the benefit
plan for the claim. Additionally, he said that DHSS has
recently become aware of situations in small communities where
the pharmacists don't have a contract with the clients benefit
plan provider, or the plan is not recognized in the system,
creating a problem that is still being addressed. He stressed
that monitoring and modifying the contingency plan is on-going,
and that individual attention is being provided by the DHSS
staff on a case-by-case basis for correct claim submission.
3:41:10 PM
CHAIR WILSON stressed that this has not been an easy transition,
and asked how DHSS is responding to the pharmacists who have
supplied clients with prescription drugs and are now
experiencing significant delays in receiving reimbursement from
Medicare, effectively incapacitating the business.
3:42:29 PM
MR. SHERWOOD offered that there could be various reasons why
Medicare has not paid claims, but he offered that through the
DHSS contingency plan pharmacists can submit/resubmit to the
state for payment.
3:43:05 PM
REPRESENTATIVE SEATON recalled that the Alaska SeniorCare
prescription drug program authorization passed through the
legislature as an interim measure, and he asked when it is
scheduled to terminate.
MS. UKOIDEMABIA responded that the SeniorCare authorization, the
SeniorCare cash assistance, and the "wrap-around" to Medicare
programs each have a sunset date of June 30, 2007.
MR. SHERWOOD explained that last year's legislature passed a
bill to extend the SeniorCare program and extended the drug
benefit to a wrap-around for Medicare, with an 18 month limit.
He explained that the wrap-around pays for the premium or the
deductible that an eligible client would be required to meet
under a Medicare Part D plan or a comparable prescription drug
plan. In response to Representative Seaton, he reported that
the SeniorCare prescription drug plan is not being widely
utilized with less than 100 people thus far enrolled, but the
SeniorCare cash plan has an enrollment of approximately 7,000.
With the exception of the dual eligible clients who were
defaulted into the system, enrollment in Medicare Part D plans
in Alaska is low. He recalled that the statistics in the CMS
report, published in January 13, 2006, show that four fifths of
the enrollees are the dual eligible clients. Feedback from the
SeniorCare office indicates that participants are "waiting to
see ... how these first months play-out before they enroll."
The open enrollment period runs through May 15, 2006, without
penalty, and he said some people are possibly trying to avoid
the "start-up headaches" by waiting.
3:47:22 PM
CHAIR WILSON stressed that every effort should be made to get
people signed up to prevent them from incurring the permanent
penalty rate, and she asked if there is an additional, intensive
outreach program planned should the enrollment figures not
increase by March 30, 2006.
MS. UKOIDEMABIA explained that information/counseling sites are
available throughout the state to assist people in choosing a
plan and enrolling. She stated that SHIP plans to increase the
number of volunteers in expectation of a run on these sites in
March and April, following a stepped-up advertising campaign.
3:49:04 PM
REPRESENTATIVE CISSNA asked whether there is adequate funding to
provide enough dedicated staff for facilitating the enrollment
of the known eligible clients. She reported a lack of outreach
information being disseminated in her district, and expressed
concern about the ability of the volunteers to provide enough
statewide services to the "very people who need it the most."
She inquired if additional funding is needed and available to
Ms. Ukoidemabia's office to accomplish this task.
3:50:38 PM
MS. UKOIDEMABIA described the make-up of the SeniorCare/Senior
Information office, which has three employees including her;
however, SeniorCare has recently authorized a much-needed
additional administrative position. She pointed out that on the
SeniorCare website a full list of the volunteers is available,
and she stated that primarily the volunteers are provided
through professional agencies. She stressed that in the
villages the volunteers visit the recipient's homes, with
wireless laptop computers to accomplish the enrollment process.
State money would be helpful to fund more outreach, train
additional volunteers, and augment the federal grants, she said.
3:53:28 PM
CHAIR WILSON inquired if DHSS submitted a state budget request
to make funds available in anticipation of these needs for
fiscal year 2005 or 2006, whether the funding was granted, and
if Ms. Ukoidemabia considers the situation to have peaked and
that activity will now begin to "simmer down."
MS. UKOIDEMABIA declined to answer the budget question, but
opined that enrollment will not simmer down "anytime soon." She
explained the continued need for additional office staff, as
volunteers fall away following the initial enrollment rush. To
further questions, she described the $40,000 outreach campaign
that is now underway, and she provided assurance that a computer
is not necessary in order to obtain information about Medicare
Part D.
3:55:21 PM
CHAIR WILSON inquired whether there is a statewide list of known
eligible clients which could be accessed and utilized to assure
that every known recipient has been assisted.
MS. UKOIDEMABIA responded that SHIP relies on the national
Medicare database as its resource.
3:56:16 PM
REPRESENTATIVE CISSNA emphasized the need for physical outreach
to access residents in their homes.
MS. UKOIDEMABIA agreed that person to person contact is the best
way to provide assistance, and additional state-funded staff
positions would be very helpful towards that end, and could
provide support to the volunteers.
3:57:50 PM
CHAIR WILSON asked what issues are addressed in the contingency
plan circulated by DHSS on February 2, 2006.
MR. SHERWOOD explained that it directs pharmacists who are not
able to get a claim paid through a client's benefit plan, to
call the First Health pharmacy line and receive an authorization
for the claim to be paid by Medicaid.
3:59:07 PM
CHAIR WILSON, opening public testimony, addressed the on-line
witnesses and asked them to limit their testimony to recent,
relevant experiences of the past 7-10 days.
3:59:58 PM
BILL ALTLAND, Owner, Whale Tail Pharmacy; Member, Pharmacy
Board, explained that he and his wife are the co-owners and
attending pharmacists of the only pharmacy on Prince of Wales
Island. He related an incident that he said is typical of what
has been occurring since December 2005:
We had a dual eligible come into our drug store this
morning, he was [randomly] enrolled in a plan that we
do not have a contract with. The reason [why] we do
not have a contract with this plan [is] because they
didn't offer us one, or we didn't ever hear [back]
from them. The contingency or transition plan, [was
to be] Wellpoint/Anthem, ... [but] we don't have a
contract with [them either] .... ... This ... Native
elder ... had maintenance medicines [which] he needed.
[The claim] wouldn't go through on the [Medicare
assigned] plan, [which] said our pharmacy was not a
participating member [the] Wellpoint/Anthem, ... 14-
step mechanism ... didn't work ... [nor could we] get
through to Wellpoint/Anthem's help desk. ... I went
ahead and transmitted these claims to Medicaid.
Medicaid rejected, [and] said that this [man is] dual
eligible ... on Medicare .... ... We called the help
desk [at] Medicare. The pharmacy help desk was
mentioned [earlier in testimony], that's about a six
step process to get a real person, and it takes a long
time in itself just to get to somebody on the Medicaid
First Health help desk, .... So, all these steps take
a long time. I ended up spending over an hour to get
to the point where I [spoke with] an actual person
from First Health, ... and they said they'd get back
to me. ... I'd gone through all the steps to get down
to the step where Medicaid is the last payer, .... ...
By this time the patient had been in our pharmacy for
over an hour, so we went ahead and dispensed the
medications. [The drugs] ... weren't paid [for],
[but] ... we did get a call back from ... the Alaska
Medicaid pharmacist. He was concerned and helpful,
but still we did not have any payment [authorization].
... First Health did call back this afternoon, and my
wife was on the phone ... trying to get ...
[reimbursement] set-up to go through on Medicaid and
that in itself took 45 minutes; tied up both of our
pharmacy business lines .... ... Hopefully this will
be getting better but it's just an indication of how
much time it takes to transmit claims in rural
area[s]. ... One last thing I want to mention is that
this [man] really had no idea what this meant, ...
[his] prescription drug plan going from Medicaid to
Medicare. ... There's been no trainer to Prince of
Wales Island, there has been no training of seniors
that I know of .... ... I don't know if it's that way
in the other rural areas of the state, but ... I had
to train two pharmacy technicians to work with our
seniors and ... folks really don't have a clue.
4:05:16 PM7
CHAIR WILSON asked how Mr. Altland's technicians have managed to
determine the appropriate plans for their clients, without the
benefit of training.
MR. ALTLAND answered that the amount of instructional materials
arriving from the various agencies, via mail and FAX, has been
overwhelming and difficult to keep up with. However, he
explained that the information has allowed them to become self-
educated on the topic. He also reported that he hired an
additional employee in December to help with this transition and
to create a list of their eligible clients, which has been used
for outreach purposes. In short, he said, "It's taken a ... lot
of time."
4:06:30 PM
CHAIR WILSON asked how many of the new benefit plans he has
contacted and requested a contract from, with or without
success.
MR. ALTLAND answered that he has contacted and received
responses from the seven Alaska plans, but only four would
contract with his pharmacy. He pointed out that he does have a
percentage of customers who were assigned to the three plan
providers unavailable to his pharmacy. Currently, he is working
with these clients to choose an alternative plan provider.
Also, the local Native clinic has been sending their seniors to
his pharmacy for assistance, even though they are not his
regular customers. He said that the Native clinic was at a
loss, not having received training and without the benefit of
computer access. Finally, he stated, ... "It's very, very
confusing, 11 plans, 28 options. ... I've been a pharmacist
for 25 years, ... it's really confusing to me, I don't see how
most seniors would have a clue."
CHAIR WILSON explored whether it would be helpful if each Native
clinic would try to do some training.
MR. ALTLAND said that he is not familiar with how reimbursement
works for third parties under the Native health system, but he
can report that many of the local Native elders don't utilize
the system, perhaps because they have private insurance or are
on Medicare. Neither, he conceded, could he say for certain how
much training may have taken place. But, he added, the Native
Health system does have a limited formulary, and he often fills
prescriptions for the clinic's patients. He expressed concern
for the Natives who have been assigned one of the three
unavailable plans and are not receiving help to re-enroll.
4:09:21 PM
DIRK WHITE, Owner, Harry Race Pharmacy & Photo, echoed Mr.
Altland's testimony, that it is a time-consuming process to
obtain a response via the telephone, estimating his labor costs
to date to be approximately $24,000 "in time that we've paid ...
to have people sit on hold." He described the impact to his
business, when his eight phone lines are tied up in Medicare
related calls, his staff cannot tend to regular business, and
customers are frustrated. Further, he reported that because his
policy is to provide a client medications, he estimates that he
is currently holding outstanding claims amounting to
approximately $40,000, "and we have no idea when we're going to
get paid." The Wellpoint/Anthem has not been helpful, nor is it
an option as a contract is required to be compliant with the
Health Insurance Portability and Accountability Act (HIPPA).
Also, he described the recent discovery that dual eligible
clients are arbitrarily being "switched over" to Medicare Part
D, without notification. He begged the need for a streamlined
process to be enacted to provide the pharmacists with an easy
means to serve the Medicare clients, and suggested an "override
code." He said, "I hope we can find somebody to ... give us
some help and some relief so we can go back to helping our
patients ... instead of being insurance agents."
4:16:38 PM
REPRESENTATIVE CISSNA thanked the pharmacists for their efforts,
and stressed the importance of their work the community.
4:17:19 PM
DON ROBERTS introduced himself as a recipient of social security
disability and a nonparticipating eligible for Medicare Part D
benefits stating, "Quite frankly, any governmental ... program
seems to be like a nightmare just to ... get registered." He
opined that the information issued from Medicaid/Medicare to
help people make this change has been "difficult, convoluted,
and devious." He stressed that anyone would have difficulty in
understanding how to choose an appropriate plan from the options
given and the instructions provided. "You should be outraged at
what people are going through," he said, and made several
predictions of widespread angst and crime that may occur when
people are not able to obtain their necessary medication(s).
4:20:13 PM
BARRY CHRISTENSEN, Pharmacist, stated that the major problems
have been adequately outlined by the previous callers. Still an
issue, however, is the communication link between the pharmacies
and the state. He reported that the last time information and
instructions were issued from DHSS it took about five days to
reach Ketchikan, and he cited the non-arrival of the information
that Mr. Sherwood reported as being disseminated to pharmacists
earlier today. Further, he stressed that the Wellpoint/Anthem
is not a workable backup and should be dispensed with,
reiterating the "no contract" problem. He reported that the co-
payment reimbursement that the state has established does work,
albeit slowly.
CHAIR WILSON asked whether it is possible for DHSS to distribute
information directly to the pharmacists via e-mail.
4:22:34 PM
MR. SHERWOOD explained that after it was made apparent to the
department that the pharmacists were experiencing delays in
receiving departmental communication, DHSS began transmitting
communications directly to the Alaska Pharmaceutical Association
(AkPhA) for distribution.
MS. UKOIDEMABIA confirmed that Nancy Davis, Director, AkPhA, has
a master pharmaceutical e-mail list that is available and being
used.
4:23:25 PM
JENNIFER ADAMS, Representative, Anchorage Community Mental
Health Services (ACMHS); Program Coordinator, Medicare Plan D,
reported that ACMHS has 600 consumers who are affected by
Medicare Plan D. She stated that since August this change-over
has become her full-time job. The goal of ACMHS has been to
provide enrollment support for their clients in an effort to
keep them as stable as possible. Unaware of the various
training possibilities, she said that she has primarily educated
herself on how to administer the program. She pointed out that
a recent article in the local newspaper was grossly erroneous in
reporting that Medicare Plan D has been successful in Alaska.
Everyday a number of her clients have trouble in accessing their
medications. Currently, she knows of two patients who are off
their medications entirely because they can neither afford the
co-pays nor handle the angst of trying to access their
medications, which includes calling multiple locations, having
to hold for over an hour at a time, and the other difficulties
involved with the new system. "The results of going off
psychotherapeutic medications can be devastating," she said,
stressing that the ACMHS community is suffering because of
Medicare Plan D. The pharmacies that she works with have had
difficulty and denied her patients their medications, when the
Wellpoint/Anthem option fell through and the assigned benefit
plans could not be accessed. Because it takes so long on the
phone, she said she is only able to assist eight individuals per
day. While the various agencies are blaming each other, none
are responding to her pleas, and she has some clients who are on
their seventh day without critical medications. Contacting
Senator Lisa Murkowski's office proved to be somewhat helpful,
and she attributed a ray of success due to that contact.
However, she stressed that this is more than frustrating and
people are suffering the effects of a failed government system.
4:27:54 PM
CHAIR WILSON asked for an example of what the co-pay costs are
for her clients.
MS. ADAMS responded that the co-pay costs range from $15.00 into
the hundreds of dollars, explaining that even a co-pay of $5.00
is exorbitant for someone who has 24 medications to purchase.
She pointed out that it is unaffordable for the people who live
on a low or fixed income. She described the roster system that
she has used to reach her eligible clients and enroll them in
the appropriate plan, and stressed that these are individuals
who are unable to self advocate or maintain enough focus of
their energy to enroll. In attempting to help these persons who
are mentally disabled, she reported that she and the clinicians
at ACMHS are entirely overburdened with the administration of
Medicare Part D. In response to a question, she said that she
has thus far managed to enroll about 400 of the 600 people on
her client list. Continuing, Ms. Adams explained how enrollment
was done in-mass beginning in November to ensure that when the
roll-over happened in January, every client would have received
a new card, understand the new plan, and not experience gaps in
coverage. Despite these efforts, enrollment did not happen, no
cards or multiple cards were received, and she said, "Come
January 3rd ... all of my efforts went down the tubes,
basically."
CHAIR WILSON conjectured that perhaps the pharmacies in the
villages have been more accommodating than the pharmacies in the
larger cities.
4:31:33 PM
MS. UKOIDEMABIA asked Ms. Adams whether she has been accessing
the Alaska SeniorCare (ASC) hotline to receive support and
assistance. She provided Ms. Adams with appropriate telephone
numbers for statewide and local dialing, and explained that
although a message will need to be left, a same-day response
will be received.
4:33:04 PM
REPRESENTATIVE CISSNA emphasized that there are only three
people trying to field an obvious statewide problem that is
reaching crisis levels. She asked what action could be taken to
correct this oversight.
4:33:55 PM
CHAIR WILSON pointed out that this is a nation-wide situation,
and the federal government was not prepared for the "glitches"
that have surrounded this change-over. She agreed that more
assistance is needed, particularly to help the pharmacists.
4:34:28 PM
MS. UKOIDEMABIA explained that in her conversations with AkPhA
it was determined how training for the pharmacists could be
incorporated into her "seniors" training classes. However, due
to the lack of flexibility with the federal funding and not
being provided state funding to accomplish this task, it has not
been possible to create a joint program.
CHAIR WILSON indicated it appears that the pharmacists now have
an understanding of the program options and how to enroll the
eligible people, but that the communication lines are basically
jammed, prohibiting access.
4:36:33 PM
MR. SHERWOOD highlighted that most dual eligible clients are
working with their pharmacists, but for anyone who is
experiencing problems he provided the recipient help line
telephone numbers, which should provide a same-day response. He
also stated that the state contingency plan is being revised as
needs arise, but he explained that this change over was
configured by the federal government to expressly make state
government assistance a last resort option, effectively
minimizing what the department is legally able to provide
through Medicaid.
4:39:03 PM
CHAIR WILSON stated that regardless of whose responsibility it
falls under, when people are unable to receive their medications
it causes problems, and she stressed that measures need to be
taken.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:39:43 PM.
| Document Name | Date/Time | Subjects |
|---|