Tobey Schule tells Senate committee Medicare plan left patients and health professionals confused

Local C-SPAN viewers saw a familiar face Wednesday morning during Senate hearings in Washington, D.C., on the new Medicare prescription drug plan.

Tobey Schule, a pharmacist at Sykes'' grocery store in Kalispell, went national with his complaints about Part D.

From Schule's perspective, the D might as well stand for disaster. The adjectives "confusing" and "frustrating" popped up frequently during his testimony.

"I work with the elderly every day, and this has been overwhelming for them," he said. "Bewildered by the complexity, some patients are choosing not to enroll."

Schule spoke at a Senate Finance Committee hearing. He was invited by Montana Sen. Max Baucus, the highest-ranking Democrat on the committee and a critic of the program's implementation.

Baucus accuses the Centers for Medicare and Medicaid Services of ignoring warnings about approving multiple plans.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 allows private health-insurance companies to offer competing plans. That approach avoided expanding the Medicare bureaucracy and was designed to lower costs through competition, the federal government says.

Schule's patients became frustrated and confused last summer when information about Medicare Part D plans began arriving, Schule said.

"With over 40 plans to choose from in Montana, my patients said they were scared and intimidated by all the options," he told the committee.

Schule said those who understood the Medicare mailings were told to check the Internet or call 1-800-Medicare for help sorting out plans.

The pharmacist said a vast majority of elderly people have no computers, and many can't navigate automated phone systems. Those who could use the phone system gave up after sitting on hold for a long time.

However, in a recently released report, Mike Leavitt, secretary of Health and Human Services, said that problem was fixed and seniors "now experience virtually no wait time" when using the 800 number.

Schule testified that meetings held locally were not much help in understanding Part D.

"After attending these sessions, many patients came back to my pharmacy saying they were even more confused," he said. "Patients received different answers from different people."

Officials guiding seniors through the process told them to focus on their medications to decide which plan offered the best deal. Schule said some faced choosing between medications when none of the plans offered all of them.

"Education for pharmacists wasn't much better," he said.

He said he heard about only one meeting given by the Centers for Medicare and Medicaid Services for pharmacists, and that meeting was in Billings. Schule said he sent a pharmacy technician to a local meeting given by an insurance counselor.

He said that seminar didn't help the pharmacy staff understand the new program well enough to help patients.

"But it did help us understand why our patients were so frustrated," he said.

Schule finally learned from his software vendor how to determine his patients' Part D drug coverage.

Other problems affected people eligible for Part D through both Medicaid and Medicare. They were enrolled automatically in plans that sometimes didn't offer all of their medications.

Schule said he invested a lot of time sorting out their problems.

"Fortunately, we are a small pharmacy and we know all our patients," he said. "So we were able to give them their medications on the spot."

But the pharmacist said he thought about all the patients across the country who must have gone without their medications.

Patients must change their medications to match the drugs offered by their plans, he said. Schule thinks this has increased the costs of physician visits, labs and hospitalizations.

He told the Senate committee that Part D shouldn't allow mail order as a option for many reasons, including lack of coordination between mail order and local pharmacies, which could increase the likelihood of problems.

He said that patients have trouble with the mail order process.

"These patients have trouble remembering to order a medication before they run out, but if they order too soon, the script will not be processed," Schule said.

Additionally, insurance companies weren't prepared for the Jan 1 startup, he said. Some patients didn't have their cards, or the information they received was incomplete.

Schule said his staff spent hours on hold, trying to talk to company representatives by phone. Sometimes they were cut off after hours spent waiting.

In his report, Leavitt admitted some plans had not anticipated the volume of calls they would receive. However, he said wait times improved during the program's first month.

Schule also complained that he must accept low reimbursement rates rather than negotiate rates with companies. The plans were slow to pay claims, he said.

"My pharmacy has over $45,000 in unpaid claims from Medicare Part D," Schule said.

Wrapping up his testimony, the pharmacist said the people setting up the program should have thought about their own elderly parents' needs. He said the program is needlessly complicated.

Based on Schule's and other constituents' experiences, Baucus wants changes to make the program less confusing.

"I study this stuff. I have expert advisers, and my head is spinning," Baucus said. "I can't imagine how hard this is on our seniors."

Baucus has called for plan standards that allow seniors to make "apples-to-apples" comparisons. He also support a move to extend the May 15 deadline six months.

In the one-month report, Leavitt said the new drug program was the most significant change in Medicare since the program started 40 years ago. He said it was unrealistic to expect no problems.

Leavitt said the drug benefit was a good deal for seniors. He said the new benefit was working for the vast majority with 24 million people enrolled.

The competitive market place has reduced the price of prescription drugs for consumers and taxpayers, Leavitt said in his report.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.