Bipartisan Group of Senators To Call for Reimbursement of States for Incurred Medicare Prescription Drug Benefit Costs
A bipartisan group of at least five senators plans to sponsor legislation that would reimburse states that are covering the costs of drugs for Medicare beneficiaries who have had difficulty obtaining medications under the new Medicare drug benefit, AP/Long Island Newsday reports. The legislation -- co-sponsored by Sens. Norm Coleman (R-Minn.), Dianne Feinstein (D-Calif.), Frank Lautenberg (D-N.J.), Charles Schumer (D-N.Y.) and Olympia Snowe (R-Maine) -- would reimburse the states for 100% of their costs plus interest.
In addition, the bill would require the HHS secretary to recover overpayments to Medicare drug plans and return the money to Medicare (Freking, AP/Long Island Newsday, 1/18). Lautenberg is expected to introduce the legislation (Campbell, Newark Star-Ledger, 1/19). Lautenberg said, "While there are many problems that need to be dealt with regarding the implementation of this drug plan, it is critical that we pay these states back as soon as possible" (AP/Long Island Newsday, 1/18).
On Tuesday, CMS Administrator Mark McClellan said the government will not reimburse states covering the costs of beneficiaries' prescriptions, adding that CMS does not have the authority to pay states directly.
The Bush administration has instructed insurers offering Medicare drug plans to provide beneficiaries with a 30-day emergency supply of any drugs they were taking before the Medicare prescription drug benefit began Jan. 1. In addition, the administration said insurers must take steps to ensure that no low-income beneficiary is charged more than $2 for a generic drug and $5 for a brand-name drug. McClellan said the agency will assist state agencies in compiling and filing claims with Medicare drug plans (California Healthline, 1/18).
At least 26 states are covering prescription drugs for beneficiaries dually eligible for Medicaid and Medicare who have been unable to obtain medications under the drug benefit, according to a survey released Wednesday by the National Association of State Medicaid Directors, the Star-Ledger reports. Thirty states responded to the NASMD survey. The survey outlined more than a dozen problems with the implementation of the drug benefit, including the following:
- Insurers offering Medicare drug plans have not yet received lists of all dual eligibles and the plans in which they are enrolled;
- In some cases, states' lists of dual eligibles do not match lists from CMS; and
- Computer programs to assist pharmacists in verifying a beneficiary's eligibility sometimes do not work or are backlogged.
Martha Roherty, director of NASMD, said drug plans were prepared to handle beneficiaries who were enrolling in drug plans for the first time but had problems with the switch of dual eligibles from Medicaid to Medicare. "The complicating factor was switching people from state Medicaid plans into the federal Medicare plans," Roherty said, adding, "The transition was not fully understood" (Newark Star-Ledger, 1/19).
Criticism of the drug benefit is "premature," Mark Merritt, president of the Pharmaceutical Care Management Association, said Wednesday during a press conference to discuss the organization's 2006 agenda, CQ HealthBeat reports. PCMA, which represents pharmacy benefit managers, will not support legislation making changes to the drug benefit, Merritt said, adding that the group "wants stable ground with no changing goal posts."
Merritt said problems with the drug benefit will get "progressively and exponentially better" in the months ahead. "We're doing a lot to manage the problems," he said, adding, "We've staffed up our call centers, added literally thousand of employees throughout our industry to make sure that people can get the information they need, pharmacists can get the information they need" (CQ HealthBeat, 1/18).
The following summarizes additional features examining effects of the drug benefit.
- Canadian pharmacies: The Washington Times on Thursday examined how online pharmacies in Canada -- "facing competition" from Medicare drug plans -- "are trying to capitalize" on the drug benefit's "bumpy start this month to keep their senior customers." Amber McBain, business development manger of OneWorldRx, a pharmacy processing company in Richmond, British Columbia, said, "Where there are lapses in Medicare D coverage, Canadian pharmacies offer an excellent complement for most people." However, a CMS official said prescription drugs often cost less through Medicare drug plans than online Canadian pharmacies. "It's also illegal for Americans to buy drugs from Canada," CMS spokesperson Peter Ashkenaz said (Higgins, Washington Times, 1/19).
- Republican response: The Washington Post on Thursday examined how some Republican lawmakers "are using town meetings and other outreach efforts to try to tamp down senior citizens' outrage over the [drug benefit] ... as they look warily toward the November elections and the possibility of a political backlash." For instance, Rep. Thomas Reynolds (R-N.Y.) attended a recent community workshop on the benefit to meet with beneficiaries and respond to their concerns. Andrew Kohut, president of the Pew Research Center, said, "This could be either the one thing that people say either, 'Wow, they really accomplished something here,' or they say, 'Look at what the Republicans have done. They've fattened up their insurance buddies and left us out in the cold'" (Murray, Washington Post, 1/19).