More than three weeks after the implementation of the new Medicare prescription drug benefit, seniors and state governments have plenty of complaints about how well it's working. Most seriously, states and advocacy groups are saying that the new program is faltering in its commitment to provide drugs to the poorest people. So-called dual eligibles, people who are eligible for both Medicare and Medicaid by virtue of being both elderly (or disabled) and poor, used to get their prescriptions through Medicaid, which offered comprehensive coverage. As of January 1, they were to instead receive the new Medicare benefit, with very low copayments and low or no premiums; if they didn't sign up on their own, they were automatically assigned a plan.

But that transition has been less than seamless, says Deane Beebe, spokesperson for the Medicare Rights Center, a national advocacy group. Some people were never assigned plans or are unaware of their new plan. Some aren't identified as low income, which means they're being charged too much for their prescriptions. Others who were automatically assigned to a plan are finding when they get to the pharmacy counter that it doesn't cover the drugs they take, or that these drugs require prior authorization from an insurer. Regular Medicare beneficiaries who signed up late in 2005 also experienced delays getting prescriptions filled when their enrollment information hadn't yet been entered in central databases. Meanwhile, insurers' help lines haven't been much help, given the heavy volume of calls.

There are no easy solutions, says Beebe. More than 20 states have passed emergency legislation to step in and pay for prescriptions that low-income seniors cannot get because of Medicare snags. And the federal government has reminded the private insurers administering the benefit that all beneficiaries having trouble with the system must be allowed at least a 30-day supply of their medications; additionally, dual eligibles should not to be charged more than $5 per prescription. Beebe advises all Medicare beneficiaries to bring as much information as they can when they go to fill a prescription: That means Medicare and Medicaid cards, and any information that they've received from the insurance company administering the plan they've chosen (or have been assigned to). Even an enrollment letter can help, she says, since it tells pharmacists what insurer they need to call for help. The government also says beneficiaries can call (800) MEDICARE to request help from a caseworker.

According to the Centers for Medicare and Medicaid Services, 24 million Medicare recipients now have drug coverage; 3.6 million people have voluntarily signed up for one of one of the new stand-alone drug plans, which are separate from other health coverage, and the rest were either automatically enrolled in a stand-alone plan, are covered by Medicare HMO that now incorporates prescription coverage or don't need new coverage because they are already using employer or union plans for their prescriptions.

"For most of them, the system is working," said Mike Leavitt, secretary of the Department of Health and Human Services, in an op-ed published last week in USA Today. He acknowledged the problems that Medicare recipients have been experiencing and said that his agency is "working with pharmacists, health plans, and states to get their prescriptions filled as quickly as possible."

For more information, go to http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/