Confusion over a new Medicare program designed to make prescription-drug coverage more available is doing the opposite for many people who need help the most.

Medicare, Part D, went into effect Jan. 1 — 45 days after patients received letters instructing them to choose from an array of private plans, or have one chosen for them.

Kat Gabriesheski, a public benefits lawyer for Legal Aid of Hawai'i, said her agency has heard from people who are having problems figuring out the new system.

"A lot of these people don't speak English as their first language," Gabriesheski said. "Many of them can't read or understand the letters." Legal Aid has helped numerous Medicare and Medicaid patients cut through the confusion and get their medicines, she said.

Some people didn't understand they needed to make a choice. Others waited too long and their applications weren't processed in time to get the cards they need to get their prescriptions starting Jan. 1.

For those patients on both Medicare and Medicaid — the poorest and most likely to be disabled, sick and elderly — that meant their old prescription plans became outdated before their new ones were in hand.

The problems here mirror glitches nationwide.

Around the country, about 6 million low-income elderly and disabled people were automatically switched into Medicare drug plans on Jan. 1, the Los Angeles Times reported.

At least one state, Vermont, found the problems for low-income beneficiaries so overwhelming that it decided to use state funds to pay their prescription bills until Feb. 10, the Times reported.

"It just wasn't working," Joshua Slen, the Vermont Medicaid director, told the newspaper yesterday.

Vermont estimated it will cost $7 million to provide the transitional coverage for its 30,000 Medicaid beneficiaries, and Republican Gov. Jim Douglas is demanding that Washington "fully reimburse" the state.

The drug-benefit plan offers outpatient prescription coverage to 43 million elderly and disabled beneficiaries through government-subsidized private plans, at an estimated cost of $700 billion over 10 years.

Gavino Yting, a 79-year-old Waialua man and World War II veteran, said he "went to the pharmacy, and they were asking regarding my new prescription drug plan card. They wanted my card, but my card could not be located, so I will not be able to get my medicine, so I went home."

Yting needs his eye drops. He has asthma and needs medicine for that condition. He's been coughing lately.

He called Legal Aid and was told that the pharmacies have numbers to call to verify enrollment. They also have a fail-safe program that allows them to bill the government during the transition.

Yting said yesterday he still thought he would wait at least one more day to see if the missing card showed up in the mail.

He said he was worried about being asked again to pay full price for the drugs.

"They told me at the pharmacy I could just pay for this — $100 for my eye drops only," he said. "I said, 'Never mind.'"

Some Medicaid-Medicare patients now need three cards — a Medicaid card, a card for their new private Medicare program and a card from the state called "Smooth Transitions" — to cover all their medical needs, so even when everything is working as planned, the process is confusing.

When the cards aren't available, phone numbers are available to pharmacies to help verify patient coverage, Gabriesheski said, but Legal Aid has received calls from pharmacists saying they have remained on hold for over an hour trying to get that information.

"You can't get through," said Anh Vo, a pharmacist at Chinatown Pharmacy on Hotel Street. "A lot of people are calling."

Even when the patients have the cards, some pharmacies are reporting problems with them, Gabriesheski said.

Richard Naito, a pharmacist at Sav-Mor Drugs in Kalihi Shopping Center, said his pharmacy has experienced problems with the Smooth Transitions card.

"There have been a lot of rejections, so people have had to pay their copayments," he said.

Joyce Kamai, a 58-year-old Makiki woman on dialysis, said she was turned down earlier this week at her pharmacy for her kidney medicines.

She called Legal Aid and then returned to the pharmacy armed with information the lawyers provided and got her medication.

"No one should have to leave the pharmacy without their medications," Gabriesheski said. "That is the message we want to get out."

But many people, such as Yting, Gabriesheski said, are afraid to go to the pharmacy without their cards, worried they will be asked to ante up payments for the drugs that would exceed their monthly incomes.

Reach Karen Blakeman at kblakeman@honoluluadvertiser.com.