Problems with access to drugs in the Medicare Part D program loom large as April approaches, according to long-term care advocates.

As of April 1, Medicare plans participating in the new Medicare drug program will be able to refuse payment for drugs that are not on the list (or formulary) of medications they cover. Prior to this date, the Centers for Medicare & Medicaid has directed plans to pay for a prescription even if it’s not on the list of drugs they cover.

Many contend that elderly and disabled Medicare beneficiaries will face new difficulties in obtaining their medicines.

“I think that, after April 1, you’re going to see huge problems with access. It’s going to be January 1 all over again,” said Tom Clark, policy director at the American Society of Consultant Pharmacists, which represents nursing home pharmacists.