Medicare Plan Brings Red Tape

Many Seniors Forced To Jump Through Hurdles To Get Needed Drugs

(CBS)  When the family of Irene Ferreira went to fill her prescription for Aricept, an Alzheimer's drug, earlier this month, the insurance company said "no."

CBS News correspondent Wyatt Andrews reports it was a shocker because Aricept is a drug covered under the new Medicare drug benefit — it said so right there in the brochure.

"Aricept is on the approved list of drugs, as long as there is prior authorization," says Ferreira's daughter, also named Irene.

According to Ferreira's daughter, prior authorization meant the doctor had to justify the prescription before insurance would pay.

"They actually wanted the doctor to provide the chart notes on her different tests that she takes," Irene says.

"Prior authorization is getting to be a bigger problem every day," says Vicki Gottlich with the Center for Medicare Advocacy.

According to advocates for senior citizens — in thousands of cases so far — drugs might be covered under Medicare, but patients still need "prior authorization" before insurance actually covers the drug.

The Center for Medicare Advocacy calls that sleight of hand.

"I think people were promised they would be able to get all their drugs they require," Gottlich says. "But they weren't told they might have to go through a little extra."

Ferreira's insurance company, Health Net of Connecticut, blamed a clerical error for the extra trouble she faced and said a prescription is waiting for her now.

But the company defended prior authorization as important for safety a spokesman said.

"Some patients take this drug inappropriately," he said in a letter, but did not mean Ferreira.

Medicare, meanwhile, has ordered insurance plans to solve this saying "we expect… prior authorization [to be] resolved at point of service," meaning the pharmacy counter.

Medicare also tells CBS News if you have this problem call 1-800-Medicare, and when someone answers, "Ask specifically for a case worker."

So now in this transition to this massive new benefit, prior authorization is yet another complication in an already-troubled program.