Beneficiaries Confused by Medicare Drug Benefit
Two-thirds of Medicare beneficiaries who have enrolled in the new prescription drug benefit are confused by the program, according to a recent Associated Press/Ipsos poll, the AP/Long Island Newsday reports. According to the poll, 52% of respondents said that the Medicare prescription drug benefit is difficult to understand.
One-third of respondents said that they have not formed an opinion on the Medicare prescription drug benefit, and 16% said that the program is not difficult to understand, the poll finds. About half of Republican respondents said that the prescription drug benefit is difficult to understand, compared with six in 10 Democratic respondents, the poll finds.
Seniors, enrolled Medicare beneficiaries, residents of rural areas and college graduates are the groups most likely to acknowledge difficulties with the prescription drug benefit, according to the poll. Among poll respondents who are enrolled in the Medicare prescription drug benefit or have family members enrolled, six in 10 said that they have not received significant savings on medications under the program.
Jean Finberg of the National Senior Citizens Law Center said, "Most of these people are vulnerable and frail. Our government is not protecting these people, and the new plan is too complicated."
CMS spokesperson Gary Karr said, "We certainly acknowledge there have been some problems. This is a $30-$40 billion program. It's a big transition for many people" (Lester, AP/Long Island Newsday, 1/23).
CMS must address problems with the Medicare prescription drug benefit in the near future "to prevent chaos in long-term care," according to a letter sent on Friday by the American Society of Consultant Pharmacists to agency Administrator Mark McClellan, CQ HealthBeat reports.
"Clearly, the transition principle of providing Medicare beneficiaries with unfettered access to medications while they transition to Medicare Part D has been violated by the plans," the letter states. According to the letter, the longer the delay in reimbursements to pharmacies and nursing homes from Medicare prescription drug plans, "the more difficult it will be for long-term care pharmacies to continue sending medications to long-term residents without payment."
The letter adds, "The current CMS approach of addressing issues one plan at a time, and one issue at a time, relying on voluntary cooperation of plans to resolve them, could take years." The letter concludes, "This tremendous variability among plans not only presents serious operational challenges for long-term care pharmacies and facilities, but also presents a threat to the provision of quality of care to long-term care residents" (Reichard , CQ HealthBeat, 1/20).
Meanwhile, Rep. Henry Waxman (D-Calif.) on Friday sponsored a briefing for pharmacists and Medicare beneficiaries to discuss the prescription drug benefit.
Pharmacist Tim Tucker, who spoke behalf of the American Pharmacists Association, called the launch of the Medicare prescription drug benefit "a fiasco." According to Tucker, recent statements by HHS Secretary Mike Leavitt that no Medicare beneficiaries "'should leave the pharmacy without their medications'" are not beneficial because some pharmacies "have reported up to $40,000 in outstanding receipts."
Pharmacists and Medicare beneficiaries at the briefing criticized how the Bush administration has handled the launch of the prescription drug benefit and raised concerns about the program.
In response, Karr said, "While there are some pharmacists who are having problems, there are many pharmacists who are able to access the systems and to make sure people get their prescriptions." He added, "While we are having problems with a few thousand people in a program that's covering 24 million people, we are working very hard to make sure that everyone who has coverage can get it." According to Karr, "It is disappointing to see this level of partisan politics enter the equation."
He said, "The expression we are hearing from nursing homes is generally very positive, but that doesn't mean people aren't having problems. Some have prepared very early for the transition and they are having even fewer problems." No congressional hearings on the Medicare prescription drug benefit currently are scheduled (Reichard , CQ HealthBeat, 1/20).
Summaries of additional newspaper coverage on the Medicare prescription drug benefit appear below.
Chicago Tribune: The Tribune on Monday examined how some pharmaceutical companies have ended programs that provide no-cost or discounted prescription drugs to seniors because of concerns the programs "could be interpreted as a kickback to win loyalty to their prescriptions" under federal law. Pharmaceutical companies cite a memo from the federal government that advises them to avoid inducements to Medicare beneficiaries to select their medications under the prescription drug benefit. However, according to HHS, pharmaceutical companies can donate medications to a third-party charity to avoid violations of federal law (Jaspen, Chicago Tribune, 1/23).
Los Angeles Times: The Times on Sunday examined how, with "the government's best health care experts having had two years to get ready," the launch of the Medicare prescription drug benefit has "stumbled so badly." According to the Times, the reasons for the problems "have a familiar ring" in that Bush administration officials "made their plans on the basis of assumptions that things would go relatively smoothly." Bush administration officials last week acknowledged problems with the Medicare prescription drug benefit but said that most beneficiaries have access to their medications (Alonso-Zaldivar/Girion, Los Angeles Times, 1/22).
New York Times: The Times on Saturday examined how problems "in the first weeks of the Medicare drug benefit have vexed many beneficiaries and pharmacists," as well as the treatment of beneficiaries with mental illnesses. According to the Times, residents of assisted living facilities who are dually eligible for Medicare and Medicaid are not exempted from copayments under the prescription drug benefit, but dual eligibles who reside in nursing homes are exempt (Pear, New York Times, 1/21).
- Washington Post: The Post on Monday profiled Tracey McCutcheon, acting deputy director of the Medicare Drug Policy Group at CMS. Since the Medicare prescription drug benefit began, McCutcheon has worked "12-hour days, taking conference calls, combing through statutory language and rethinking the fine print of 60 pages of federal regulations she helped to write" on the program, the Post reports. McCutcheon said that "some of the specific issues that come up have been surprising," adding that "you never bring up a huge program and have everything perfect" (Goldstein, Washington Post, 1/23).
Summaries of recent opinion pieces addressing the Medicare drug benefit appear below.
- Jonathan Chait, Los Angeles Times: The Medicare prescription drug benefit "is the perfect issue for Democrats to run on" in 2006 because it "perfectly encapsulates the corruption of Republican Washington," Chait writes in a Times opinion piece. However, "[r]unning on this issue makes so much sense that naturally the Democrats won't do it," he adds (Chait, Los Angeles Times, 1/22).
- Michael Hiltzik, Los Angeles Times: The Medicare prescription drug benefit's "doughnut hole" - a gap in coverage between $2,250 and $5,850 in annual costs - is "one reason that fewer than four million" seniors eligible for the stand-alone drug benefit have enrolled voluntarily, Times business columnist Hiltzik writes. He adds, "When a government program is defined in terms of a void at its core, you know it's trouble" (Hiltzik, Los Angeles Times, 1/23).
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