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Tough decisions on Medicare drug benefit await consumers
McClatchy Newspapers


June 14, 2005

Washington - With critical deadlines looming, millions of elderly and disabled Americans on Medicare can anticipate tough and complicated choices in enrolling in the new federal drug program that begins next year.

"It will be a challenge," said Mark McClellan, the federal official in charge of getting the $720 billion, 10-year program off to a smooth start.

Robert Hayes, president of the Medicare Rights Center, an advocacy group in New York, is even more ominous.

"Only the savviest consumers will be able to navigate it on their own and even with assistance," he said. "Millions of elderly and disabled people face a bewildering range of options that will cause anxiety and a significant risk of exploitation and intimidation."

But Gary Karr, spokesman for the Centers for Medicaid and Medicare Services, insisted that the selection process will be "a lot easier than it seems."

About half the 43 million people eligible for the new benefit will be assigned automatically into drug insurance programs. The others might seek help from family, pharmacists and advocacy groups gearing up for the kickoff of the program.

"Most seniors will not have to wade through a bewildering list of choices," Karr said.

For those not automatically enrolled, crunch time will begin Oct. 1, when private insurance companies, including sponsors of health maintenance organizations, are permitted to start their sales pitches through newspaper, radio and TV ads, and direct mailings.

Oct. 1 will open a period of about six weeks in which Medicare beneficiaries are expected to start analyzing and digesting competing plans to see which works best for them.

The window for signing up opens on Nov. 15. While there's no prize for an instant decision, the quicker the better so that people can be enrolled and claiming the benefit from the outset.

The window that opens Nov. 15 will shut on May 15. After that, beneficiaries face a 1 percent a month penalty on their premium when they do sign up.

McClellan said the schedule provides enough time for beneficiaries to review their choices and make them, drawing if needed on the advice of family, pharmacists and others.

The vast majority of the nation's nearly 200,000 pharmacists are bracing for an onslaught of questions from customers, said Mary Ann Wagner, vice president of the National Association of Chain Drugstores.

Beneficiaries will "probably be a little confused by the choices and they'll turn for advice to the pharmacists who regularly dispense their drugs," she said.

The pharmacists, in turn, may rely heavily on a drug price scorecard developed by Gold Standard Multimedia Inc., a private health information technology company in Tampa, Fla.

Gold Standard's president, Russ Thomas, said in a telephone interview that pharmacists, consumers and advocates are testing software that could make it easier to figure out the best choice for each patient.

Such a system would go a long way toward alleviating a beneficiary's confusion and anxiety, Thomas said.

Once obstacles are overcome, the benefit could offer considerable help to millions who rely heavily on drugs to ease pain and control illness. Rising drug prices have driven some Medicare beneficiaries to choose between buying medicine and food, patient advocates contend.

McClellan said the plan could save the typical beneficiary $100 a month in drug costs, and for people who have big drug expenses, thousands of dollars a year.

About 43 million people are eligible for the new benefit, approved by Congress and signed into law by President Bush in 2003. Medicare covers about 36 million elderly and 7 million people under 65 with permanent disabilities.


Distributed by Scripps Howard News Service.

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