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April 1 deadline could bring new problems for Medicare drug plan

WASHINGTON - Many elderly and disabled Americans enrolled for the Medicare drug benefit will face new difficulties in obtaining their medicines on April 1, say advocacy groups familiar with the program.

On that date, insurers will have more latitude to tell pharmacists that they won't pay for a particular drug. Before that, insurers have been told that they should pay for a prescription even if it's not on the list of drugs they cover.

"I think that, after April 1, you're going to see huge problems with access. It's going to be January 1 all over again," said Tom Clark, policy director at the American Society of Consultant Pharmacists.

Government officials said the Medicare drug benefit covers most of the drugs commonly used by seniors and the disabled. They say beneficiaries who take those drugs will have nothing to worry about come April 1.

And, if beneficiaries find that their drugs are not on a plan's list of drugs covered, often referred to as the formulary, then they usually will have access to substitute medicines. The poorest beneficiaries can switch plans at any time.

"What we're requiring is that the formularies all must be broad, all must meet our stricter-than-usual requirements, plus there must be a timely way for beneficiaries to get an exception," said Mark McClellan, head of the Centers for Medicare and Medicaid Services.

[Last modified March 18, 2006, 02:30:29]