Almost 15 percent of Floridians who rely on Medicare live in Hillsborough, Manatee and Pinellas counties. That includes about 142,000 in Hillsborough alone, or about 13 percent of our population.

These Bay area seniors are confused by the complexity of the new Medicare Part D prescription drug program. I join with them, health care professionals and community volunteers to advocate substantial reform to Medicare Part D, based upon what we have seen:

•The new drug program forces Medicare recipients into HMOs for their prescription drugs. In Florida, there are 43 drug plans to choose from. Each offers a confusing array of drugs, prices and pharmacies that can abruptly change. Patients generally are locked into the plan they select until the limited open enrollment - only 45 days a year.

• The state cut transportation for dialysis patients when Medicare Part D came online, even though Part D does not cover their frequent and medically necessary trips to clinics for treatment. At the urging of local dialysis clinics, the county commission instituted emergency assistance to these patients.

•LifeLink Foundation, the nonprofit organ transplant agency, and Tampa General Hospital report that transplant patients are having difficulty obtaining and affording immunosuppressive drugs that are necessary after an organ transplant.

• Independent pharmacists are taking out huge lines of credit to provide necessary medications because the HMO drug companies are not providing timely reimbursement or coverage. Despite the best efforts of pharmacists to find them, Medicare beneficiaries are being told that they are not enrolled. Just as distressing, they are discovering that their drugs are not covered or that they must pay higher co-payments and deductibles than they can afford. Many patients therefore walk away without receiving the drugs they need.

• Unscrupulous HMO salesmen are using the confusion to recruit seniors into their primary care Medicare programs, Parts A and B, which reduces medical services for many.

Reforms should be swift and meaningful to address the delays, confusion and escalating costs.

1. Substantially revamp the program into an efficient and user-friendly system like the existing Medicare arrangement.

2. Allow the government to negotiate wholesale bulk prices for drugs, as Veterans Affairs has done since 1992, rather than divert huge profits to the HMOs.

3. Extend the enrollment deadline date, currently May 15, to the end of this year. This would allow seniors the time they need to understand their options without incurring a 1 percent monthly penalty.

As a local government official, I can testify that the confusion and complexity are forcing patients to turn to state and local government for safety net services.

If you or your parents or neighbors need assistance, please contact SHINE (Serving Health Insurance Needs of Elders) at 1-800-96-ELDER or the Hillsborough County Health and Social Services at 272-5040.

Most importantly, send a message to Washington to reform the current program with a simpler one now.

Kathy Castor is a Hillsborough County commissioner and a candidate for Florida's 11th Congressional District.