Today in San Antonio, Texas, the National Association of County & City Health Officials is recognizing the Baltimore City Medicare Part D Surveillance and Response Initiative as a model practice in public health.

Read the press release.

Read a snapshot of the initiative.

Read the July 2006 evaluation report, which reviews the initiative to date.

Baltimore City's Medicare Part D Surveillance and Response Initiative remains in operation. To date, we have received 152 reports from pharmacists of patients who are having problems with Medicare Part D. We have committed funds to pay for emergency supplies of medication for 59 patients at a cost of $12,637.00.

On June 16, at the request of the Commission on Aging and Retirement Education, we expanded surveillance to include problems with the "donut hole." This is the gap in support for non-subsidized enrollees whose cumulative drug costs have reached $2250 and whose Medicare drug benefit won’t kick in again until their costs reach $5100.

Pharmacists who encounter patients facing the Medicare "donut hole" should fax a referral to us. We will work with the Commission on Aging and Retirement Education to find out whether the patients may qualify for subsidized coverage. While we will not be able to pay for medications for patients in the "donut hole," we are interested in understanding the impact of this problem in Baltimore City. This information could lead the way to advocacy and additional policy development.

Additional updates will be posted.

Pharmacists continue to contact Baltimore City’s Medicare Part D Surveillance and Response initiative, and we are still helping patients. Our collaboration with the Commission on Aging and Retirement Education (CARE) is continuing. CARE is still reaching out to patients identified by city pharmacists and helping them to solve coverage issues.

To date, we have received 142 reports and have provided direct assistance to pharmacists to resolve Part D problems in 84 cases. We have committed funds to pay for emergency supplies of medication for 44 patients at a cost of $10,340.00.

This week a pharmacist reported the case of a 57-year old diabetic patient who could not afford the cost of her insulin and her blood pressure medication. Her qualification for dually eligible status in November 2005 was not yet in the system, and she was not immediately enrolled in a Part D plan. Instead, she signed up for a plan and must wait for her coverage to take effect on May 1. The Health Department paid for her interim medications and referred her to CARE for case management services.

We anticipate a surge in enrollment as the May 15 deadline for voluntary enrollment without additional charges (which applies to many enrollees) approaches. Many of those enrolling may be low-income who qualify for low co-payments. Please see the attached schedule of information and enrollment sessions led by CARE.

Additional updates will be posted.

Baltimore City is extending its Medicare Part D Surveillance and Response initiative through the end of April.

We continue to receive pharmacist reports of patients who did not make it into a plan, or whose plan does not include their pharmacy or their particular medications, or who are being charged inappropriately high deductibles and co-payments.

Recent reports from pharmacists include a 78-year-old man whose Part D plan had changed its formulary twice since January 1, forcing his provider to switch his cholesterol medications twice and re-order liver function tests each time. We also received a report of an indigent patient (receiving Medicaid) whose Part D plan adequately covered her HIV medications in January but has since removed those medications from their formulary.

To date, we have received 138 reports and have provided direct assistance to pharmacists to resolve Part D problems in 79 cases. We have committed funds to pay for emergency supplies of medication for 46 patients at a cost of $9,819.88.

The decision to extend the surveillance initiative was based on three factors:

(1) Drug plans can change their formularies every month, pharmacies can move in and out of network, and states must continually send lists of vulnerable low-income patients for enrollment. As a result, there is the potential for ongoing transition difficulties.

(2) We anticipate a surge in enrollment as the May 15 deadline for voluntary enrollment without additional charges (which applies to many enrollees) approaches. Many of those enrolling may be low-income who qualify for low copayments.

(3) We are still being contacted by pharmacies and helping patients.

Our collaboration with the Commission on Aging and Retirement Education (CARE) is continuing. CARE is still reaching out to patients identified by city pharmacists and is leading the effort in Baltimore to prepare for the May 15 deadline.

The Medicare Part D Surveillance and Response Initiative has received reports of more than 135 problems with Medicare Part D and has responded immediately to pharmacists' requests for assistance in dozens of cases.

Here are some examples:

Baltimore City received a report of an 85-year old woman who was enrolled in both the Medicaid and Medicare program. The pharmacist was unable to fill her glaucoma medications. The claim submission failed for lack of enrollment information. The Baltimore City pharmacy officer on call authorized $244.29 to purchase her meds and referred her to the Commission on Aging to ensure she has drug coverage. Her coverage problems were then addressed.

Baltimore City received a report of a 56-year-old disabled man on three cardiovascular medications. Even though he had received a letter stating he was enrolled in Medicare Part D, the pharmacist could find no record of any enrollment information. The Baltimore City pharmacy officer on call authorized $207.06 to ensure these medications were provided. The patient was able to enroll for a plan to start two weeks later.

Baltimore City received a report of an 80-year-old man who was being substantially overcharged for eight essential medications, including medications for blood pressure. The Baltimore City pharmacy officer on call authorized $168.28 to cover the medications. A case manager from the city Commission on Aging and Retirement Education followed up with the patient to ensure he is properly enrolled.

Baltimore City paid $126.05 to cover an essential asthma medication for a 41-year-old woman with a disability. The pharmacist reported he had been on hold with a Medicare drug plan for three hours before calling the city surveillance line. He then put the patient on the phone. She told the Baltimore City Pharmacy Officer on call that she was terrified to go home without her medication.

Baltimore City received a report of a disabled woman whose Medicare Part D plan formulary would not cover her oral contraceptive. The pharmacy officer on call authorized payment.

Baltimore City received a report from a pharmacist that 11 low-income patients at a nursing home were being charged excessive co-payments by the same Medicare drug plan. The pharmacist provided a few days of medication, while I wrote the drug plan to request their immediate attention to the problem. The drug plan responded to the letter, called the pharmacist, and fixed the co-payment problem.

Baltimore City received a report of an 84-year-old woman who had been dropped in the transition of her drug coverage from Medicaid to Medicare Part D. She urgently needed medication for hypothyroidism, asthma, and cardiac arrhythmia. The Baltimore City pharmacy officer on call authorized $234.54 for her medications. The Commission on Aging and Retirement Education then followed up and scheduled her for an enrollment session at a local senior center.

Baltimore City received a report of an 80-year-old woman who has diabetes and is dependent on insulin. The pharmacist could not obtain her medications through Medicare Part D, and he had already advanced her an 8-day supply. Baltimore City paid $237.39 for additional medicine and is continuing to work to ensure she has adequate coverage.

Baltimore City received a report of a low-income 78-year-old woman with depression, cardiovascular disease, and respiratory difficulties requiring seven different medications. Instead of a minimal fee, she was being charged a deductible of $250 and a high co-payment. The Baltimore City pharmacy officer on call authorized $279.29 to ensure she has access to essential medications.

Baltimore City received a report of a 62-year-old disabled HIV+ man whose Medicare Part D plan was refusing to cover his HIV medications because they were not on formulary. The pharmacy officer on call authorized a payment of more than $1200 to cover a month's supply.

The Baltimore City Medicare Part D Surveillance and Response Initiative has received reports of 124 significant problems with Medicare Part D. Pharmacies have reported 48 instances of Medicaid drug coverage not automatically transferring to a Medicare Part D plan as expected, and 12 reports of low-income patients whose coverage did not automatically transfer from state Pharmacy Assistance to a Medicare Part D plan.

Another commonly reported problem is excessive out of pocket expenses. The Health Department has received 51 reports where a Medicare Part D plan substantially overcharged a low-income patient whose prescription costs were previously covered by Medicaid or Maryland Pharmacy Assistance Plan (MPAP).

The Baltimore City Medicare Part D Surveillance and Response Initiative is helping. Dozens of vulnerable city residents have received essential medications because of the city’s efforts. The Health Department has provided direct assistance to pharmacists to resolve Part D problems in 70 cases. To date, the Health Department has committed funds to pay for emergency supplies of medication for 36 patients at a cost of $7,057.16.

While the number of calls declined as implementation of the Medicare Part D program has progressed, spending authorizations still remain significant into the eighth week of implementation. Both the number of calls and their spending authorizations peaked in the second week. After the second week reports decreased, but an increasing proportion of the calls have required the Health Department to intervene and purchase medications. As a result, the amount of money authorized has remained significant (Click to Download Figure).

Based on these continuing expenditures, and based on information from the state of Maryland indicating that several thousand eligible low-income seniors and individuals with disabilities may yet to be enrolled in Medicare Part D, the Medicare Part D Surveillance and Response Initiative has been extended through the end of March.

The Baltimore City Commission on Aging and Retirement continues to reach out to all patients identified as having problems with Medicare Part D by city pharmacists. The agency is also helping help other city residents who are contacting them directly with Medicare Part D problems.

Additional updates will be posted.

The Baltimore City Medicare Part D Surveillance and Response Initiative has received reports of 117 significant problems with Medicare Part D from more than 44 pharmacies in 19 different zip codes of Baltimore City. Of these, 61 reports have come by fax and 56 by phone.

The Baltimore City Health Department has provided direct assistance to pharmacists to resolve Part D problems in 63 cases. Early on in the initiative many interventions were to help pharmacists navigate the system, and sometimes the Health Department ended up authorizing payment for medications. At this point, however, reports are fewer and come from pharmacists who have tried those channels unsuccessfully, so the Health Department is authorizing payment for proportionally more of the reports. The percentage of reports that resulted in payment authorization rose from 6% in week 1 to 42% in week 3, 35% in week 4, and 50% thus far in week 6.

To date, the Health Department has committed funds to pay for emergency supplies of medication for 30 patients at a cost of $6042.48. In each of these cases, the patients would not otherwise have had access to the medication. In a number of additional cases, pharmacies have provided emergency supplies of medication at their own expense.

Based on the pharmacy reports, the Commissioner of Health in Baltimore City has sent advocacy letters to the leadership of twelve different Medicare Part D plans on behalf of 36 Baltimore residents. These letters explain the problems experienced by pharmacists and request immediate attention by the plan. Eleven of the plans have contacted the Health Department and followed up with the local pharmacist, with known resolution of several problems.

The Health Department has also faxed instructions on how to attempt to resolve common Part D problems to all city pharmacies.

The three most common problems remain:
Excessive out-of-pocket expenses. The Health Department has received 41 reports where a Medicare Part D plan substantially overcharged a low-income patient. This has been a particularly difficult problem for pharmacists to resolve, because many have had trouble reaching the plans to resolve the problem.

Failure to enroll automatically. Pharmacies reported 45 instances of Medicaid drug coverage not automatically transferring to a Medicare Part D plan as expected. A few patients have been able to enroll these "dual eligible" patients in the 14-day backup plan established by Medicare.

Failure to transition from state pharmacy assistance. The Health Department has so far received 12 reports of low-income patients whose coverage did not automatically transfer from state Pharmacy Assistance to a Medicare Part D plan.

The Baltimore City Commission on Aging and Retirement continues to reach out to all patients identified as having problems with Medicare Part D by city pharmacists. The agency is also helping help other city residents who are contacting them directly with Medicare Part D problems.

Additional updates will be posted.

The Baltimore City Medicare Part D Surveillance and Response initiative has been extended through at least the end of February.

The Health Department has now received reports of 112 significant problems with Medicare Part D from more than 43 pharmacies in 19 different zip codes of Baltimore City. Of these, 59 reports have come by fax and 53 by phone.

To date, the Baltimore City Health Department has provided direct assistance to pharmacists to resolve Part D problems in 59 cases. The Health Department has committed funds to pay for emergency supplies of medication for 28** patients at a cost of $4960.44. In each of these cases, the patients would not otherwise have had access to the medication. In a number of additional cases, pharmacies have provided emergency supplies of medication at their own expense.

Based on the pharmacy reports, the Commissioner of Health in Baltimore City has sent 17 advocacy letters to the leadership of twelve different Medicare Part D plans on behalf of 36 Baltimore residents. These letters explain the problems experienced by pharmacists and request immediate attention by the plan. Nine of the plans have contacted the Health Department and followed up with the local pharmacist, with known resolution of several problems.

The Health Department has also faxed instructions on how to attempt to resolve common Part D problems to all city pharmacies.

The three most common problems remain:

Excessive out-of-pocket expenses. The Health Department has received 40 reports where a Medicare Part D plan substantially overcharged a low-income patient. This has been a particularly difficult problem for pharmacists to resolve, because many have had trouble reaching the plans to resolve the problem.

Failure to enroll automatically. Pharmacies reported 43 instances of Medicaid drug coverage not automatically transferring to a Medicare Part D plan as expected. A few patients have been able to enroll these "dual eligible" patients in the 14-day backup plan established by Medicare.

Failure to transition from state pharmacy assistance. The Health Department has so far received 12 reports of low-income patients whose coverage did not automatically transfer from state Pharmacy Assistance to a Medicare Part D plan.

The Baltimore City Commission on Aging and Retirement continues to reach out to all patients identified as having problems with Medicare Part D by city pharmacists. The agency is also helping help other city residents who are contacting them directly with Medicare Part D problems.

Additional updates will be posted.

**corrected from 30 patients on 2/9/2006.

On Tuesday January 24th, Baltimore's Health Commissioner testified on Medicare Part D before the Committee on Health and Government Operations in the Maryland House of Delegates. You can read his testimony.

The Baltimore City Medicare Part D Surveillance and Response Initiative has received reports of 94 problems with Medicare Part D from more than 39 pharmacies in 18 different zip codes of Baltimore City. Of these, 48 reports have come by fax and 46 by phone.

To date, the Baltimore City Health Department has provided direct assistance to pharmacists to resolve Part D problems in 47 cases. The Health Department has committed funds to pay for emergency supplies of medication for 19 patients at a cost of $2952.08. In each of these cases, the patients would not otherwise have had access to the medication. In a number of additional cases, pharmacies have provided emergency supplies of medication at their own expense.

Based on the pharmacy reports, the Commissioner of Health in Baltimore City has sent twelve advocacy letters to the leadership of ten different Medicare Part D plans on behalf of 29 Baltimore residents. These letters explain the problems experienced by pharmacists and request immediate attention by the plan. Nine of the plans have contacted the Health Department and followed up with the local pharmacist, with resolution of at least 12 problems.

The Health Department has also faxed instructions on how to attempt to resolve common Part D problems to all city pharmacies.

The three most common problems remain (Figure) :

Excessive out-of-pocket expenses. The Health Department has now received 31 reports where a Medicare Part D plan substantially overcharged a low-income patient. This has been a particularly difficult problem for pharmacists to resolve, because many have had trouble reaching the plans to resolve the problem.

Failure to enroll automatically. Pharmacies reported 31 instances of Medicaid drug coverage not automatically transferring to a Medicare Part D plan as expected. A few pharmacists have been able to enroll these "dual eligible" patients in the 14-day backup plan established by Medicare. However, what will happen to these patients at the end of 14 days remains a question.

Failure to transition from state pharmacy assistance. The Health Department has so far received 9 reports of low-income patients whose coverage did not automatically transfer from state Pharmacy Assistance to a Medicare Part D plan.

In addition, the Health Department has received 11 reports of patients who were assigned to a Part D plan but the plan has no record of that patient.

The Baltimore City Commission on Aging and Retirement continues to reach out to all patients identified as having problems with Medicare Part D by city pharmacists. The agency is also helping help other city residents who are contacting them directly with Medicare Part D problems.

Additional updates will be posted.

The Baltimore City Health and Response Initiative has received reports of 77 significant problems with Medicare Part D from more than 30 pharmacies in Baltimore City. Of these, 45 reports have come by fax and 32 by phone.

To date, the Baltimore City Health Department has provided direct assistance to pharmacists to resolve Part D problems in 30 cases. The Health Department has committed funds to pay for emergency supplies of medication for 10 patients at a cost of $2039.73. In each of these cases, the patients would not otherwise have had access to the medication. In a number of additional cases, pharmacies have provided emergency supplies of medication at their own expense.

Based on the pharmacy reports, the Commissioner of Health in Baltimore City has sent nine advocacy letters to the leadership of eight different Medicare Part D plans on behalf of 21 Baltimore residents. These letters explain the problems experienced by pharmacists and request immediate attention by the plan. Six of the plans have contacted the Health Department and followed up with the local pharmacist, with known resolution of several problems.

The Health Department has also faxed instructions on how to attempt to resolve common Part D problems to all city pharmacies.

The three most common problems remain:

Excessive out-of-pocket expenses. The Health Deaprtment has received 25 reports where a Medicare Part D plan substantially overcharged a low-income patient. This has been a particularly difficult problem for pharmacists to resolve, because many have had trouble reaching the plans to resolve the problem.

Failure to enroll automatically. Pharmacies reported 23 instances of Medicaid drug coverage not automatically transferring to a Medicare Part D plan as expected. A few patients have been able to enroll these "dual eligible" patients in the 14-day backup plan established by medicare. However, what will happen to these patients at the end of 14 days remains a question.

Failure to transition from state pharmacy assistance. The Health Department has so far received 9 reports of low-income patients whose coverage did not automatically transfer from state Pharmacy Assistance to a Medicare Part D plan.

The Baltimore City Commission on Aging and Retirement continues to reach out to all patients identified as having problems with Medicare Part D by city pharmacists. The agency is also helping help other city residents who are contacting them directly with Medicare Part D problems.

Additional updates will be posted.