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Glitch slows Medicaid prescription processing

October 25, 2006|by KAREN HANNA

WASHINGTON COUNTY - A computer glitch has forced some people covered by a state Medicaid program to pay for their prescriptions out of pocket and even go without in the past few days, local pharmacists said.

Pharmacists and state officials Tuesday offered differing views on the severity of the problem, which affects people covered by Maryland Physicians Care.

"Some of them, we've been selling to them on a limited supply to help hold them," said Gary Haas, a pharmacist at Boonsboro Pharmacy. Other people have taken a wait-and-see approach to the problem, which Haas said arose Saturday.

"If they're running out of medications, we don't have any other way to handle that," Haas said. A few people have gone home without their medications, he said.

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Jeff Gruel, director of the pharmacy program for the Maryland Department of Health and Mental Hygiene, said Tuesday he was not sure how many people are covered by Maryland Physicians Care. The managed-care organization is one of seven that provides health coverage to about 490,000 low-income Marylanders, he said.

According to Gruel, a "breakdown in communication between computers," has hampered prescription processing. He said Tuesday he was unaware of anyone being turned away from pharmacies without the drugs they needed.

To address the problem while the computer malfunction is being fixed, Gruel said pharmacies have been notified they may submit claims for payment.

John Hammond, a state health department public affairs officer, said Tuesday evening the problem came to light just a few hours earlier.

"It is an issue we at the department are aware of. We are working to correct the problem," Hammond said in a voice-mail message left Tuesday.

Dave Russo, the pharmacist at Russo's Rx in Hagerstown, said Tuesday he had received no information from the state. He characterized the problem as "just an inconvenience," that has forced pharmacy employees and customers to make a few more phone calls or trips to pick up prescriptions than usual.

"We have the option of lending people medications, so they're not out. If they had (the prescription) before, we're at little risk of not being compensated," Russo said.

Russo said a handful of people had come to his pharmacy with Maryland Physicians Care cards since Saturday. Only one person, who had a prescription for a controlled drug, left with nothing, he said.

At Boonsboro Pharmacy, about 60 Maryland Physicians Care customers tried to fill their prescriptions between Saturday and Tuesday evening, Haas said.

About 20 percent opted to pay out of their own pockets for portions of their doses to "hold them" over until the problem can be fixed. The rest are waiting out the problem, Haas said.

"We're out in limbo. We're trying to take care of business. We can't be on the phone all day with the state," Haas said.

Even if the state could verify the claims of Haas' customers, Haas said the pharmacy can not afford to give out medications without payment.

"It's easy for them to give out the money. They've got a barrelful, and we're trying to make a living," Haas said.

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