About 37M Medicare Beneficiaries Have Drug Coverage
More than one million Medicare beneficiaries enrolled in the new prescription drug benefit between late April and May 6, bringing the total number of beneficiaries with some form of prescription drug coverage to 37 million, HHS Secretary Mike Leavitt announced on Wednesday, CQ HealthBeat reports (Carey/Crowley, CQ HealthBeat, 5/10).
The total includes about 8.9 million beneficiaries enrolled in stand-alone Medicare prescription drug plans, including 2.1 million beneficiaries receiving a low-income subsidy, HHS said. The total also includes 5.9 million beneficiaries enrolled in Medicare Advantage plans, including 940,000 beneficiaries receiving the low-income subsidy.
About 490,000 of the low-income beneficiaries in MA plans are dual eligibles, according to HHS. HHS said that about 1.4 million beneficiaries included in the stand-alone PDP and MA plan totals are retirees who receive coverage through unions or former employers that also receive a subsidy from Medicare.
Other groups that comprise the total include:
- About 5.9 million dual eligibles who were automatically enrolled in stand-alone PDPs;
- About 6.9 million retirees who receive employer- or union-sponsored coverage with Medicare subsidies who are not in PDPs or MA plans;
- About 3.5 million retirees enrolled in TRICARE -- the military health program -- or the Federal Employee Health Benefits Program (HHS release, 5/10); and
- An estimated 5.8 million beneficiaries with coverage through the Department of Veterans Affairs or other sources of coverage at least as good as Medicare (CQ HealthBeat, 5/10).
On April 20, the last time enrollment data were released, HHS said about 35.8 million beneficiaries had some form of drug coverage (California Healthline, 4/21).
May 15 is the last day most beneficiaries can enroll without paying a penalty. The Bush administration has said beneficiaries eligible for the low-income subsidy will not be penalized for late enrollment.
Leavitt said, "I am very pleased with this increase in enrollment" (Snowbeck, Pittsburgh Post-Gazette, 5/11). He added, "To have [this many] enrolled in the first year would be historic."
In the new enrollment data, HHS lowered its estimate of the number of beneficiaries who are eligible for the low-income subsidy, USA Today reports. The agency now estimates that 13.2 million beneficiaries are eligible for the subsidy, compared with a previous estimate of 14.4 million.
HHS spokesperson Peter Ashkenaz said the changes were made after Medicare officials consulted with the Social Security Administration (USA Today, 5/11).
However, some advocacy groups and Democratic lawmakers questioned the accuracy of the new data and the way the Bush administration is presenting the numbers (Carey/Crowley, CQ HealthBeat, 5/10).
Families USA said in a statement, "This sudden disappearance of 1.2 million low-income seniors makes the administration's enrollment performance appear better than warranted" (USA Today, 5/11).
Robert Hayes, president of the Medicare Rights Center, said his group estimates that about nine million beneficiaries do not have drug coverage. He said, "No amount of exaggeration can disguise two central facts: over 80% of impoverished people with Medicare eligible for a comprehensive drug benefit have not enrolled; nearly 51% of the people with Medicare who had no drug coverage on Jan. 1 still have no coverage" (Carey/Crowley, CQ HealthBeat, 5/10).
Hayes also questioned the accuracy of the statement that 5.8 million beneficiaries have drug coverage through the VA or other sources. "In fact, many of these ... do not have coverage, and many others of them have signed up [for the drug benefit] and are thus being counted twice," he said.
Tricia Neuman, a Kaiser Family Foundation vice president and director of its Medicare Policy Project, said, "It's important that people who are estimated to have drug coverage actually have it." She added, "I know there are a lot of questions about the numbers, but they are moving forward" (Alonso-Zaldivar/Gerstenzang, Los Angeles Times, 5/11).
Rep. Pete Stark (D-Calif) said, "According to the Bush administration's Enron-style accounting, at least 6.5 million people remain without any prescription drug coverage. But the real number ... lacking comprehensive coverage is undoubtedly higher" (Carey/Crowley, CQ HealthBeat, 5/10).
CMS Administrator Mark McClellan said the enrollment data are accurate, adding, "Those are firm numbers" (Los Angeles Times, 5/11).
Meanwhile, President Bush promoted the drug benefit in an event with beneficiaries at a community organization in Central Florida, the Washington Times reports. "There's a May 15th deadline coming up," Bush said (Curl, Washington Times, 5/11). He added, "It's very important for people to understand that there are significant savings for you involved in this plan" (Los Angeles Times, 5/11).
Meanwhile, congressional Democrats held a rally in Washington, D.C., to call for an extension of the enrollment deadline (Fletcher, Washington Post, 5/11).
House Minority Leader Nancy Pelosi (D-Calif.) said the drug benefit is "confusing, and it's complex." She added, "Seniors deserve more time. Seniors do not deserve to be taxed for the rest of their lives because of this corruption" (Freking, AP/Philadelphia Inquirer, 5/11).
Senate Minority Leader Harry Reid (D-Nev.) said, "The White House botched the implementation of the prescription drug plan, and millions have been unable to navigate their way through the confusing sign-up process. Democrats believe they shouldn't be penalized for it" (Washington Times, 5/11).
Sen. Debbie Stabenow (D-Mich.), citing a recent Government Accountability Office report that said one-third of calls made to Medicare help line operators are answered inaccurately or with inadequate information, said, "Why would we penalize seniors and the disabled because the government can't get its act together?" (Freking, AP/Boston Globe, 5/11).
In related news, Johnson & Johnson and at least four other pharmaceutical companies are seeking approval from the HHS Office of Inspector General to jointly offer a patient assistance program that would help low-income Medicare beneficiaries pay for medications in the so-called "doughnut hole" coverage gap in the prescription drug benefit, J&J Health Care Systems President David Martin said on Wednesday, Reuters reports. Under the prescription drug benefit, beneficiaries are responsible for 100% of total annual drug costs between $2,250 and $5,100 (Richwine, Reuters, 5/10).
Medicare then covers 95% of drug costs beyond $5,100. Martin, who did not name the other pharmaceutical companies involved in the program, made the announcement a day before CEOs of several pharmaceutical companies are scheduled to meet with the Senate Finance Committee to discuss their PAPs.
Martin said the program J&J is proposing would target seven million to nine million Medicare beneficiaries with incomes between 151% and 200% of the federal poverty level. Under the program, called Companion Rx, the companies would pay 65% of drug costs in the doughnut hole, with beneficiaries paying the remaining 35%, Martin said.
According to Martin, the value of the prescriptions would continue to count toward the $5,100 in total annual drug costs before the Medicare coverage resumes. The program would cover generic as well as brand-name drugs, he said. Martin added the participating companies are seeking to add other pharmaceutical companies to the coalition.
The coalition has met with the HHS OIG, the Federal Trade Commission, CMS and Finance Committee staffers.
Meanwhile, Eli Lilly on Wednesday said it will continue to operate its existing LillyAnswers PAP through the end of the year for Medicare beneficiaries who were enrolled in the program as of Dec. 31, 2005 and have not yet signed up for the Medicare drug benefit. Lilly next year will launch a new LillyMedicareAnswers PAP for certain low-income Medicare beneficiaries who have enrolled in the drug benefit. Lilly currently is seeking OIG approval for the new program, which will help beneficiaries obtain the osteoporosis treatment Forteo and the antipsychotic Zyprexa.
The drugs covered under LillyMedicareAnswers would not count toward the $5,100 catastrophic coverage trigger. To be eligible for the new program, beneficiaries must have been denied the low-income Medicare drug benefit subsidy available to beneficiaries with incomes below 150% of the federal poverty level, but their incomes must not exceed 200% of the poverty level (Reichard, CQ HealthBeat, 5/10).
Separately, TAP Pharmaceuticals said it will continue its PAP for some beneficiaries. TAP said the program will be available to beneficiaries not enrolled in the drug benefit, "provided that all eligibility requirements are satisfied" (Japsen, Chicago Tribune, 5/11).