By Crystal Swann
January 16, 2006

On December 21, 2005, Baltimore Mayor Martin J. O’Malley announced that Baltimore City would conduct around-the-clock surveillance to identify problems associated with the implementation of the new Medicare Part D, prescription drug program. In addition, the city will respond with direct assistance to residents who are experiencing difficulties with Part D.

Medicare Part D is the new prescription drug benefit available to everyone enrolled in Medicare. Beginning January 1, for those who have signed up or who have been automatically enrolled, competing private insurance plans will be providing drug coverage for millions of seniors. Each plan has it’s own formularies, list of pharmacies, sets of co-payments, premiums and deductibles.

In Baltimore City, between 28,000 and 105,000 residents are expected to initiate drug coverage with Medicare Part D on January 1, 2006 – including tens of thousands of low-income and vulnerable residents who are disabled or elderly. This new program is expected eventually to provide many Americans with important financial protection in the event of illness. However, the scope, abruptness, and complexity of the switch are unprecedented. According to the Governmental Accountability Office (GAO), logistical problems with this transition could lead to disruption of treatment, inappropriate hospitalization, and premature nursing home placement.

“When just one person switches drug coverage, that’s a health insurance issue,” said O’Malley. “When as many as 50,000 people switch on the same day, that’s a public health issue. As a result, we are taking innovative steps to protect some of our most vulnerable residents from losing access to essential medications during the transition to the new insurance program.”

The Baltimore initiative builds upon its existing biosurveillance network. Pharmacies will be able to report problems with Part D by internet, fax and phone. Baltimore’s health department will team up with the city’s Commission on Aging and Retirement Education to provide prompt intervention.

One outcome measure of this initiative is that the city will track high blood sugar in elderly patients presenting to area hospitals, which is often a sign of poor access to medications.

The Medicare Part D Surveillance and Response initiative may serve as a model for other cities with high populations of persons eligible for Medicare Part D. More information about Baltimore’s program, including its complete plan, may be found at the website www.baltimorecitymedicare.org

Baltimore City’s Medicare Part D Surveillance and Response Initiative has five objectives:

1. 24-hour reporting by pharmacies to the Health Department of problems experienced by city residents with Medicare Part D;

2. Follow-up support by the city’s Commission on Aging and Retirement Education to all Baltimore City residents identified as having problems with Medicare Part D;

3. Immediate intervention to prevent Baltimore City’s poorest and most vulnerable residents from forgoing essential medications during the transition, including drawing from a $50,000 reserve fund for medications;

4. Advocacy on behalf of city residents if private Medicare drug plans consistently fail to meet expectations on coverage; and

5. Assess the outcome of Medicare Part D implementation and the performance of the Health Department to mitigate problems.

For more information or to review Baltimore’s Complete Plan go to the website www.baltimorecitymedicare.org