Drug coverage off to rocky start

Many Americans jokingly refer to any situation rife with confusion or chaos as “a Chinese fire drill.”

I have never been to the large Asian nation, so I can’t say I know what a Chinese fire drill looks like. However, I suspect they are better run than the new prescription drug plan benefit known as Medicare Part D, at least from the outset of the new program.

Millions of Americans had to switch from Medicaid to Medicare to get prescription drug coverage as of Jan. 1. My wife Colleen is legally blind and classified as disabled because of it, so she is on Medicare.

The trepidations we both had as Jan. 1 approached turned out to be well founded.

I knew pharmacies would be swamped during the changeover of provider coverage, so I waited until Jan. 6 to drop off five prescriptions at Uptown Drug. Owners Paul Lewis and Pat Lonnon-Lewis have always gone above and beyond in helping us get Colleen’s medications filled in a timely manner.

Yet I could sense the frustration they were dealing with in getting prescriptions filled through the many Medicare drug plans out there.

Fortunately, they have exceptional employees in assistant store manager Christy Robinson and pharmacy technicians Marion Mullenax and Carol Carpineta to help consumers navigate through the minefield of red tape.

When I went back to the store later on Jan. 6, I expected nothing and that’s what I got. Robinson called me aside as I approached the counter and said the prescriptions were filled, but none had “gone through” the system, meaning I would have to pay cash if I wanted them then and there.

When I asked how much they would come to, she replied, “You don’t want to know.” I did not inquire further, asking her to keep after Sierra Rx, which is Colleen’s Medicare Part D provider.

Robinson made another photo static copy (Pat Lonnon-Lewis made one during the Christmas week) of Colleen’s drug coverage card and promised she would.

I waited until Tuesday to check on the status of the prescriptions. Carpineta said they still would not go through, so I called a service representative with Sierra Rx and asked what is going on?

She verbally gave me the three vital pieces of information on Colleen’s card – RxBIN number, RxGrp number and member ID number. The member ID on the card contains a hyphen before the last two digits and the representative told me to have pharmacy personnel put it through without the dash.

I called Carpineta and relayed the message.

Three of the five “scrips” finally were approved and I picked them up for a simple co-payment. Carpineta provided me with a computer printout of each one, its cost and an explanation of why Prevacid and Topamax were still rejected. It was not a case of the two drugs not being on the Sierra Rx formulary, but rather they would not pay for them in the dosages and frequency ordered by Colleen’s doctors.

At this point, I should tell everyone that I called Sierra Rx several weeks before the plan went into effect and went over Colleen’s entire medication list with a representative.

Several were not on her list as I stated by brand name, but nearly all were covered when I mentioned generic equivalent names on the bottles.

What I did not inquire about, and the representative probably would not have been able to tell me, was what dosages and frequencies of medication would be paid for by Sierra Rx. That’s where we ran into trouble at the pharmacy.

The printout indicated the cost of a month’s supply of Prevacid and Topamax as ordered by the doctors came to $523.64. I commented to the clerk at the counter we’d soon be in the poor house if we had to pay those prices out of pocket.

I contacted the offices of the two doctors and got employees there to check with the doctors and then call in new prescriptions in the dosages and frequencies Sierra Rx would authorize and they did so.

When I contacted Uptown Drug on Wednesday I was told the two prescriptions were being filled. A phone call later indicated both were ready and I went to pick them up.

It turned out the two bottles originally filled the week before were waiting with the full price tag attached to them. That’s where Mullenax came to the rescue.

I don’t know specifically what she did, but she got both drugs approved as ordered in the revised prescriptions. The Prevacid was authorized at one pill daily.

Oddly, Topamax was approved at a larger dosage of two 50 mg tablets daily, instead of the four 25 mg pills daily we had been getting. I don’t understand the difference, but I thanked Mullenax for her efforts.

I’m sure many readers can relate to our experiences in dealing with the new Medicare Part D benefit, which led to much hair pulling the first two weeks.

Most seniors probably would prefer something as smooth flowing as a waltz. Instead, they were turned on their ears for some break dancing.

To borrow part of Walter Cronkite’s closing good night from his many years of anchoring the CBS Evening News, “That’s the way it is.” I would simply add, “when dealing with Uncle Sam.”

Terry Organ is the Miner’s education, health and weather reporter.