Michael Hales, Utah's acting Medicaid director, said Friday that his agency will pay drug costs for residents who qualify for both Medicare and Medicaid and can't get their medications. The state's "dual eligibles" - up to 23,000 people - were supposed to be automatically enrolled in private prescription-drug plans Jan. 1, but many have encountered problems with their coverage.

"This is not a solution for everyone," Hales said, adding residents should attempt to work through Medicare or their new private insurer first.

He said the state will begin staffing a hot line - 800-662-9651 - this weekend to assist residents or pharmacists who still run into problems.

Hales said the state's decision was based on the likelihood Utah would end up paying money one way or another for dual eligibles, given the possibility a lack of medication could require them to seek other treatment.

"We're looking at minimizing the out-of-pocket expenditure by limiting hospitalization and covering the drugs," he said.

Utah is one of at least 17 states that now have adopted similar emergency plans - even as the federal government is warning states it won't provide any financial help.

The state's move came as pharmacists throughout the state endured a second week of glitches with the new Medicare drug program.

Pharmacists say they are spending hours on the phone haggling with insurance companies, handing out drugs they have not yet been compensated for and hoarding samples to tide over clients as they cope with problems.

"It's an absolute joke," said Reid Barker, executive director of the Utah Pharmacy Association, based in Orem.

Some dual eligibles are discovering they have been deemed ineligible, weren't put in a program, face higher co-payments or are in plans that don't cover drugs they need.

"It is my impression that most dual eligibles don't even know there has been a change in their coverage," said Kathy Goodfellow, owner of Mountain View Pharmacy in Bountiful.

Many pharmacists also are having problems processing prescriptions for other new enrollees because their information has not yet been registered by insurance companies.

"I've got people who can't find about a third of the enrollees in any system," Barker said.

Goodfellow, incoming president of the Utah Pharmacy Association, figured she had filled $5,000 in uncompensated prescriptions before she managed to get many claims through to insurers Friday. She still has an outstanding tab of $1,000.

"It could turn into a cash flow problem if this continues," Goodfellow said. "It is unfortunate that the burden of this whole program has been put on pharmacies."

Deane Beebe, spokeswoman for the Medicare Rights Center, called pharmacists "the heroes in all this," though they are "not charities that can keep giving away free drugs."

The center, an advocacy group based in New York, had predicted many poor and disabled people would have trouble getting drugs under the new program and even attempted, via the courts, to get the federal government to set up a safety net.

"The people from Medicare have assured us from the start it was going to be just fine," Beebe said. "The federal government continues to deny it is an issue."

Medicare Administrator Mark McClellan is blaming glitches on the health insurance companies, according to an interview with United Press International that will air this weekend on C-SPAN. McClellan also said the federal government will not reimburse states for prescription payments they make.

"People are in Medicare drug plans, and it's the plans that are supposed to pay for people's prescriptions," McClellan said.

Hales said Utah will be "challenging" Medicare to "step up and cover the costs" of helping beneficiaries.

"Even though that is the stated policy, reality will dictate that is not the fair thing for Medicare to do - to walk away and say it is not going to pay for drugs even though they should have been covered," Hales said.

Medicare's stance doesn't do much to ease the pressure faced by Evan Stapley, owner of Stapley Pharmacy in St. George, who said Friday he has run into major problems.

"We spent over four hours yesterday on the phone with Humana trying to get through to a person for three customers," he said. "They told us we would have to call another number and the wait could be another two hours. They are so overwhelmed they cannot keep up with it. It's ridiculous."

Like other pharmacists, Stapley is making sure no one goes without medication, even if it means handing out one or two tablets at a time.

Bearing the brunt of breakdowns in the system are the mentally ill, patients especially vulnerable to gaps in drug coverage because medication is their primary form of treatment. Doses require constant monitoring, must be administered regularly and are expensive.

"Some of our patients spend $2,000 a month on drugs. The pharmacies are reluctant to cover that with no guarantee they'll be reimbursed," said Kay Stewart, a nurse at Davis County Behavioral Health.

Stewart and Davis County Medical Director Michael Stevens have been spending long hours on hold with Medicare insurers trying to sort through the mess for their two dozen patients. Some patients appear to have no coverage, while others landed in plans that don't cover their drug brands.

"We're cobbling together drug samples and trying to get them into meds at least for another week," said Stewart. "The drug companies have really come to the rescue."