Some pharmacy programs nearly ground to a halt as the new Medicare Part D prescription drug program got off to a very uneven start last week.
Supermarkets told SN of computer glitches, the inability to get through on information phone lines and pricing inconsistencies, but others said the launch of the massive benefit program was as good as could be expected.
From the consumer perspective, it was a matter of the early bird getting the worm, as those who were ready and approved had few problems. For others it was a vastly different story, and it was the store-level pharmacists who had to help patients get medications they needed, in some cases, to stay alive.
"Systems delays were significant and we were unable to process many customers' claims, so we instructed our pharmacists to give those customers a supply of medication that would get them through the next couple of days," said John Fegan, senior vice president, pharmacy, Ahold USA, Braintree, Mass.
The same was true at Ukrop's Super Markets, Richmond, Va., where John Beckner, director of pharmacy and health services, said pharmacists made sure patients with problematic scripts left with enough medication to last until the pharmacy could put the claim through.
The delays were caused by a combination of an overloaded Medicare eligibility-verification computer system, insurance companies overwhelmed with call volume from pharmacists trying to verify eligibility, and claims by a large number of customers who had not yet received identification cards from their insurance companies.
In about 15% to 20% of these cases, member information was found to be incorrect, or an enrolled member had not yet been entered into the computer system, Beckner said.
The eligibility database, maintained by Medicare contractor NDCHealth Corp., Atlanta, was improving every day, the retailers reported.
With the initial heavy volume after the New Year's holiday weekend, the system's process times were running slow, but NDCHealth is continually adjusting the system. "By the third day, the system was working according to what we consider normal processing time, which is a response [in less than a second] for most inquiries," said Robert Borchert, spokesman for NDCHealth.
Still, pharmacies have been experiencing mixed results. On Monday morning, one Ahold store was unable to process 12 out of 15 customers, while another store sent eight out of eight customers home with their prescription claim completed and their medication received with a new lower co-pay, Fegan said.
"The good news is the system hasn't come crashing down," said John Coster, vice president of policy and programs, National Association of Chain Drug Stores, Alexandria, Va. "Slow computer and customer help-desk times are what you would expect in the initial startup of a massive new benefit."
Meanwhile, pharmacists are going the extra mile to make to make sure people get at least some of their medication, retailers said. This includes staying on the phone for as long as it takes with companies to resolve coverage and making sure the people called "dual eligibles" - those who were switched from coverage under Medicaid to the new Medicare plan - understand their new payment structure.
"Dual eligibles were not paying any co-pay under Medicaid and are now paying from one to three dollars," Coster said.
Nonetheless, within three days of the plan's start over a million people across the country who needed prescriptions have gotten them, said Barbara Cebuhar, spokeswoman for the Centers for Medicare and Medicaid Services, Baltimore.
"Slow response times from plans and a flooded computer system were, for the most part, expected. Slow response was one of the 'knowns,'" Beckner said.
Even with all of this happening, there is no way for supermarket pharmacies to directly gauge enrollment or the exact number of new pharmacy customers just yet. "There are no projections out there on how the number of newly insured patients will break out to each store, so we are just anticipating a high potential number," Beckner said.
As people come to understand the new Medicare Part D and how it can help them, "we expect that enrollment will increase each month and spike around May," said Ash Yerasi, spokesman for Safeway Pharmacy Operations.