Baltimore Takes Creative Tack on New Drug Benefit
The federal government isn't releasing data on problems with its new Medicare prescription drug plan. But it's clear there are glitches. The federal government has just increased the number of operators for its pharmacists' assistant phone lines from 150 to 4,500. The city of Baltimore is treating the start of the program like a public health emergency by setting up a quick response center to help pharmacists.
The health department is sending officials to every pharmacy in the city. And they're finding problems.
Dr. Tamara Johnson, a resident in preventive medicine at the University of Maryland, is working for the health department. She's come to a Neighborcare pharmacy in a working class neighborhood in Baltimore. She asks pharmacist Dawn Jacobs how things are going. "It's been a very difficult transition," Jacobs says. "We're having a lot of patients having problems with their insurance companies, and that's causing a major problem for us."
Johnson offers help. She tells her the city can pay for emergency prescriptions to tide people over. She can assign a caseworker to help customers with enrollment problems. She's got information on a little used federal fallback program that Jacobs can bill on behalf of customers who aren't in the system yet.
Baltimore city health commissioner Dr. Joshua Sharfstein set up the program. He looks at it like this: "When you have 28,000 of the most vulnerable people in Baltimore switching health insurance on the same day, it is a potential health threat."
He's set up a "situation room" for planning and data collection, and a 24/7 call-in line for pharmacists.
Recently, the program received a fax from pharmacist John Bullinger. He has a patient with asthma and diabetes, and she's a cancer survivor. She did have a letter saying she was enrolled, but she wasn't listed in the computer.
Bullinger said until he called the city, he hadn't been able to find any help. "We've had numerous problems," he said. "Earlier this week I was literally on hold and bouncing between phone calls for two hours with one patient."
A senior vice president for Neighborcare, Stanton Ades, is in charge of pharmacies in a four-state region. He says the city program is making things a lot easier for Baltimore pharmacies. "We have one number to call," he says, or pharmacists can "fax the information, we can phone the information, we can e-mail the information to the Baltimore city health department and know they're going to get on it right away."
All this costs money. The budget for the Baltimore plan is $100,000. Sharfstein sees it as money well spent. The program is funded through the end of January. If the calls keep coming, Sharfstein says they're likely to continue it.
The center has been getting about five to 10 calls a day. It's tapped into the emergency funds for seven people. Sharfstein says he's seen one worrisome sign. Baltimore hospitals have been watching for elderly patients with high blood sugar, a sign they're not taking insulin. Yesterday, a hospital that usually sees zero or one such case a week reported that it had seen four. The hospital is contacting those patients now to see whether the patients had had problems purchasing their insulin.
Meanwhile, more than a dozen states are coming up with assistance plans of their own. They're simply paying for the drugs for people who used to get their drugs through Medicaid, but are now having problems. Medicare and Medicaid chief Mark McClellan says Baltimore's plan and state plans are fine with him. "By working with us, we can identify the plans that people are in, we can correct any problems their beneficiaries are having in obtaining coverage, and that's why many states are working closely with us."
He says such programs will only be necessary for a short period of time.
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