Zyprexa

This is known as a "step therapy" requirement, and it was supposed to be waived during the first several months of the Medicare drug program.

But many drug plans are insisting on the requirement, said Galletta.

The start-up of Medicare's huge new drug program has been bumpy for tens of thousands of seniors, and in recent weeks more than 20 states have stepped up to ensure that consumers continue to get their medication.

Another issue for nursing home residents is that early information indicates at least 100,000 of them nationwide somehow got lost in data exchanges and weren't assigned to a Medicare drug plan by Jan.

1, as expected, said Tom Clark, director of policy and advocacy for the American Society of Consultant Pharmacists.

If residents previously received their drugs through Medicaid - a joint state and federal health program for the poor - they shouldn't be charged substantial co-payments on drugs now.

But because of data issues, those co-payments are being billed in many cases.

"I have hundreds and hundreds of these charges sitting on my desk and accruing every day," said John Stoecklin at HealthOne of Southern Illinois, based in Marion.

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