Published Online: Saturday, April 1, 2006

Medicare officials have acknowledged what thousands of community pharmacists know only too well—the new Part D prescription drug benefit continues to be plagued with widespread eligibility verification problems that have left many seniors without necessary medicine.

In a new advisory to consumers facing difficulties getting medications at their pharmacies, the Centers for Medicare & Medicaid Services (CMS) is suggesting that patients pay for prescriptions out of pocket—but only as a "last resort." These patients should save their receipts and work with their health plans to get reimbursed for these costs, the advisory said. Most of the verification problems have affected people who enrolled in Part D but need a prescription filled before their identification card is sent to them.

"After your prescription drug plan has processed your enrollment application, you should get an acknowledgment letter or confirmation letter from the plan you joined," CMS told Medicare recipients. "Take your acknowledgment or confirmation letter with you to the pharmacy until you get a membership card."

Those who have not received an official confirmation should present the pharmacy with "a welcome letter from the plan, an enrollment confirmation number, or a copy of an enrollment application signed by a plan representative," the agency said.

"If you need to get a prescription before you get your letter or membership card, let your pharmacist know your plan name, and bring one of the items above to get your prescriptions—it just may take some extra time," CMS said.

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