In mid-January, many poor and disabled Californians were being deprived of prescriptions under Medicare's new drug plan, so Gov. Arnold Schwarzenegger signed legislation approving $150 million to cover medications for up to 30 days. The contribution was effective as of Jan. 12 for the state's more than 1 million Medi-Cal/Medicare beneficiaries, also known as dual eligibles.

These patients had obtained free prescription drugs through Medi-Cal until Dec. 31, then were switched to a commercial drug plan under Medicare Part D. But dual eligibles were unable to fill their prescriptions because the computer system that should have electronically linked pharmacists with their drug plans did not work. Patients accustomed to a minimal or no co-pay were now being asked to pay lots more.

"The governor has saved thousands of lives [with this action], and we applaud him," says Jack Lewin, MD, CEO of the California Medical Association. "This may be the single most-important healthcare action he has taken as governor."

Even prior to the computer glitch, physicians serving dual eligibles were complaining about the requirements of Medicare Part D. Medicare asked dual eligibles to choose a private health plan under Medicare Part D, or they would be placed in one by default.

"Medi-Medi patients who didn't choose a plan were often assigned to a plan that did not cover the prescriptions they needed," says Mary Harward, MD, an Orange geriatrician. "I warned many of my patients about the default switch. I told them to choose a plan that would meet their needs or one would be chosen for them. So many of my patients were able to avoid this problem."

But others weren't so fortunate, and were unable to get the prescriptions they needed. "Medicare Part D has been a disaster for many patients and is causing widespread confusion for them and physicians," Dr. Lewin says. "My e-mail is full of notes from physicians telling me the hours they are spending with patients just trying to get them the medications they need."