I didn’t think the Medicare Prescription Drug benefit could get any worse. Turns out, I just didn’t wait long enough:

Many prescription drug plans are changing benefits. Beneficiaries are changing from one plan to another. New plans are entering the market. Some beneficiaries will find they can no longer use the drugstores they have been using.

“There will be surprises and shocks for some beneficiaries,” said Michael J. Negrete, vice president of the California Pharmacists Association.

About 600,000 poor people are losing the guarantee of extra assistance that covered nearly all their drug costs this year.

“Starting Jan. 1, 2007, you will no longer automatically qualify for this extra help,” the Bush administration said in letters sent recently to these beneficiaries.

Some may still be able to obtain extra help. But they need to apply to a federal or state agency, and few have done so.

Pharmacists and insurance counselors say many of the 600,000 beneficiaries will not discover the change in their status until they show up at pharmacies next month. Then they could be charged $25 to $50 or more for drugs that cost them only $3 or $5 this year.

Druggists say they also foresee problems for another group: 300,000 low-income people who will be reassigned to plans chosen at random by the federal government.

Even people who stay in the same plan may face surprises because some of their drugs may no longer be covered. Plans can change the list of covered drugs from one year to the next, dropping some and adding others.