The state has picked up the tab for hundreds of prescriptions for poor and disabled Hawai'i residents during the past two weeks as pharmacists, insurance companies and low-income patients struggle to navigate confusing changes caused by the new federal Medicare Part D drug benefit.

The program offers drug coverage to 43 million senior citizens and disabled people in the Medicare program across the country. When it launched on Jan. 1, it also began providing drug coverage to 6.4 million low-income patients who got their medications through the state and federally funded Medicaid program.

In Hawai'i, the federal Medicare Part D drug program could affect up to 184,000 people on Medicare statewide, including more than 26,000 people who are eligible for both Medicare for the elderly and the federal Medicaid health program for the poor and disabled.

The most serious problems so far have been among residents who are eligible for both Medicare and Medicaid, people who were automatically switched from traditional Medicaid drug coverage to Medicare Part D drug coverage at the end of the year.

That group encountered problems because some did not receive their new medical cards by New Year's Day, when their old coverage expired. Some didn't know what plan they were enrolled in, or didn't have other information the pharmacies need to file claims.

When they showed up at Hawai'i pharmacies trying to fill prescriptions, some pharmacists found it almost impossible to contact the Centers for Medicare and Medicaid Services or the drug plans to confirm the dualeligibility patients were actually eligible and enrolled.

"All of the help line numbers that they gave us to call have been totally unavailable," said Phyllis Robinson, pharmacist with the Ululani Pharmacy in Hilo. In some cases, the lines were all busy or callers spent a long time on hold.

"I was on 20 minutes one day, and I was on an hour on Saturday, and then it hung up on me after all that," Robinson said. "It's been stressful, but we're trying to take care of the patients and not send them off not knowing what to do."

Hawai'i was the only state in the nation that had a program in place on Jan. 1 to pay for prescriptions for the dual eligibility Medicaid-Medicare population if the patients' claims could not be processed through the federally sponsored drug plans, said Tracy Okubo, legislative assistant to the director of the state Department of Human Services.

The Hawai'i fail-safe program is a "pay and chase" program where the state pays the claims to make sure the patients get their medicine, and then seeks reimbursement from Medicare or its Part D plans.

"On our end, we don't feel there should be any reason why patients aren't getting their drugs," Okubo said. When state officials hear a pharmacy has turned away a dual-eligibility patient, they contact the pharmacy to remind them of the state program to pay those claims.

"Our administration felt that this was important, and we made a commitment to protect our duals from these problems happening," Okubo said. "We wanted to make this as seamless as possible."

Okubo said the state paid 480 claims under the fail-safe program from Jan. 1 to Jan. 4. More recent statistics were unavailable yesterday, but Okubo said the total number of claims the state pays will depend on how quickly the federal government can iron out problems with its system.

It is still unclear how much the program will cost because the state will seek reimbursement from the federal system.

Kookie Moon-Ng, medical assistance program officer for Med-QUEST, said the state has committed to running the contingency program through January, but may extend it if the problems with the federal system persist.

"We know that it's working, we know people are walking away with their drugs," she said.

There is general agreement the federal system was overwhelmed after the changeover on Jan. 1. About a dozen states including California and Illinois have announced they also will temporarily pay for prescriptions for dual-eligible clients.

"It's getting better, but very slowly, I'm afraid," said Mary Rydell, Pacific area representative for the Centers for Medicare and Medicaid Services.

Rydell said the national system increased the size of its staff to answer telephone inquiries from 400 to 4,000 late last week, and said improvements in the computerized system pharmacists use to confirm Medicare eligibility and plan enrollment is now working about 80 percent of the time.

That's hardly perfect, but is significant improvement over the first days of the changeover, she said.

The state also set up a program to pay the Medicaid-Medicare patients' drug co-payments after Dec. 31. The dual eligibility patients didn't need to make co-payments under Medicaid, but would have been required to make co-payments when they were switched to Medicare Part D.

To avoid that, the state set up a Pharmacy Assistance Program to cover the co-payments for the Medicaid patients who were shifted to Part D. But that program has had glitches, pharmacists said.

"Although they promised to cover them, the system to bill for them doesn't work," Robinson said. When the pharmacy workers submit claims to recoup co-payments, the computerized system rejects the claim, she said.

"There's something wrong with the way we're sending it, but nobody can figure out how to fix it yet," Robinson said. "It may be working for other people's software, but for my software, it doesn't work."

Still, since the state made it clear those customers were not to be charged a co-payment, so Robinson doesn't. "We're pretty much fronting that part of it," she said.