Debut of drug cards greeted with a shrug

The people at AARP are still surprised. After sending out 26,000 enrollment kits for the new Medicare prescription-drug discount card, only 400 people had signed up as of last Friday. That's right, 400. That's not a typo.

Starting this week, more than 7 million seniors could begin using the much-ballyhooed cards, which the Centers for Medicare and Medicaid Services (CMS) contends can save them up to 18 percent on brand-name drugs. But with more than 70 options to choose from, an Internet-based system for comparison shopping, and glitches galore, millions of eligible seniors like Mary Telsa remain cardless. "I haven't signed up ... because I don't understand how to get enrolled," says the Hollywood, Fla., senior.

Drug-card watchers say myriad reasons are to blame for the sluggish response to the biggest expansion of Medicare in a generation. Top among them is confusion. Many seniors are just overwhelmed by the program's complexity, let alone the challenge of going online. A close second is knowledge. A Kaiser Family Foundation survey from April found that more than half of seniors didn't know a discount card was available.

Then there are questions about how much the card carriers will actually save. Two new studies find that drug price inflation over the past year may have already eaten up the much-vaunted discounts. And critics are quick to point out that it will still be cheaper to get prescription drugs from Canada and certain Internet pharmacies. "The nonresponse is not surprising," says Robert Hayes, president of the Medicare Rights Center in New York. "It's a combination of the complexity of the program and the meagerness of the benefit for most people."

But supporters are counseling patience. It's needed, they say, for the market competition to begin actually bringing prices down, for Medicare to iron out all the wrinkles, and for seniors to understand the program. "For many people, there are an exceptionally large number of choices," says Elinor Ginzler of AARP, the seniors' lobby. "So it's not unrealistic to think that it will take time to sort through all of their card options."

AARP has also started a massive state-by-state campaign to educate seniors about the cards, as well as an aggressive outreach to low-income elderly who may be eligible for a $600 discount. (Even the program's harshest critics agree the subsidy is a good thing.)

Last week, Tommy Thompson, secretary of Health and Human Services, also announced that CMS would spend $4.6 million to get more poor seniors to take advantage of the subsidy. It's also tripled the number of workers to answer questions on its 800-Medicare help line.

Private groups have also stepped in to help seniors and caretakers understand the program's nuts and bolts. WebMD, which is the leading source of medical information on the Internet, has joined forces with CMS, the Kaiser Family Foundation, and the National Council on Aging to produce a Web portal (www.webmdmedicare.com) to help seniors understand which card would be best for them.

• Jennifer LeClaire contributed to this report from Hollywood, Fla.